Sustainable Sanitation Solutions: East Africa’s Outlook

Tuesday December 15 2020
Students wash hands.

Students use the newly constructed facilities at Atse Nakutole’ab School, supported by WaterAid Ethiopia. PHOTO | COURTESY

The year 2020 marks 10 years since water and sanitation was officially declared a human right by the United Nations General Assembly (UNGA), entitling universal access to water and sanitation for both personal and domestic use. This is reaffirmed and acknowledged by Sustainable Development Goals (SDGs) particularly SDG 6 on water, sanitation and hygiene (WASH).

Although there have been great strides in sanitation, availability of decent toilets and sewage systems remain out of reach for billions around the world. The World Health Organization (WHO) estimates around 4.5 billion people to be living without sanitation worldwide.

Rapid urbanization has led to an increase in informal settlements. This growing urbanization challenge is further compounded by the frequent extreme weather events including heavy rainfall and rising sea levels – often causing damage to already weak sanitation infrastructure and facilities in these settings. Without adequate sanitation, harmful pathogens found in human waste can end up in water sources; thus, putting the health and livelihoods at risk of infectious diseases.

Inadequate sanitation perpetuates a vicious cycle of disease and poverty, because when

communities do not have access to decent toilets and clean water, disease spreads fast.

Urgent attention and action is required to ensure elimination of open defecation, scaling up of sustainable and inclusive fecal sludge management and scaling up of investment in sanitation services to address sanitation challenges in the region and accelerate progress towards the Sustainable Development Goal 6 on WASH. Urgent action is also required to ensure elimination of open defecation, scale up of sustainable and inclusive fecal sludge management and to scale up of investment in sanitation services.


With increased and sustained investment in sanitation facilities and infrastructure, communities can withstand the impacts of climate change such as floods and stay safe from diseases.

In this editorial feature, WaterAid demonstrates how its work in the region is rising to the sanitation challenge.

WaterAid East Africa’s response

The East African region is rapidly changing – economies are growing fast, and societies are becoming increasingly urbanised. With this come opportunities to reduce poverty levels and increase access to water, sanitation and hygiene (WASH). We work in Tanzania, Rwanda, Uganda and Ethiopia to create an enabling environment for WASH to become a catalyst for national development.  Our areas of work in the region include climate change, integrating WASH into health and education outcomes, civil society strengthening and institutional development, programme support and capacity building.

Sanitation and climate change are two sides in one coin

In Tanzania, WaterAid has been a key partner to the Government through the city utilities in constructing the faecal sludge treatment plant, which recycles sludge and wastewater into fertilizer produces biogas. This solution is helping Temeke residents in dealing with human waste in a crowded city with little sewers.

Tanzania is the 26th most vulnerable country to climate change and is already experiencing rising temperatures and heavier rainfalls (USAID, 2018). In October 2020, intense rainfalls caused 12 deaths, extreme floods, considerable damage to water and sanitation infrastructures, and destruction of homes and businesses in Dar es Salaam.

Climate change and un-improved sanitation

The Temeke Municipal is the most populated area in the city and, similar to other municipalities, has been heavily impacted by flooding. Teodora Nzingo, 80, lives in the coastal ward of Kigamboni, where flooding had prevented her from using her toilet and stopped sanitation services from accessing it:

Teodoro Nzingo.

Teodoro Nzingo. PHOTO | COURTESY

“The floods have also brought challenges to the toilet. It is causing me difficulty. When the sanitation business came to empty my pit latrine, they couldn’t because the flood water had gone into the storage tank. So, I can’t empty the toilet, and it is full. I can’t use it anymore.” said Teodora Nzingo, 80, beside her flooded toilet.

Responding to sanitation and climate change challenges

In response to these challenges, WaterAid Tanzania has been a critical partner to the Government, has worked the city utility to construct the fecal sludge treatment plant. This plant recycles fecal sludge and wastewater into fertilizer and produces biogas. This solution is helping Temeke residents in dealing with human waste in a crowded city with little sewers. The construction of technologies such as Decentralized Wastewater Treatment Systems (DEWATS) in Kigamboni and Temeke Municipal allows pit-emptying to be done in a hygienic way and the safe disposal of waste.

What now?

More remains to be done. The expansion of city-wide inclusive sanitation, urban settlements planning, mainstreaming climate risks mitigation, adopting sanitation technologies and services, integration of sanitation in the development of the master plan, especially in the growing or small towns, will massively contribute to sustainable sanitation for all.

Realizing gender equality through inclusive and gender sensitive sanitation infrastructure

Ethiopia has made great strides in advancing the role of women in the leadership over the past years. The year 2018 was marked by the achievement of gender parity in cabinet and the appointment of Ethiopia’s very first female President, Her Excellency President Sahle-Work Zewde. During Her Excellency’s inaugural address on 25th October 2018, she emphasized support towards gender equality in Ethiopia. In line with this pledge ‘the Ethiopian President’s National Initiative’ was launched to address gender equality, peace building and social development through civic engagement.


Building on this timely opportunity, WaterAid Ethiopia has partnered with the President’s Office through the Ethiopian President’s National Initiative to advocate for access to water, sanitation and hygiene (WASH) for women and girls as a key enabler for inclusive and quality education, unleash girls’ and women’s potential to attain their inner agency, shape and influence Ethiopia’s development.

WaterAid Ethiopia has championed an inclusive WASH facility in schools with ten toilet cubicles, one changing room for girls to use during menstruation, a waste disposal facility for used sanitary towels/ pads and a water supply tanker. 

The project was piloted in Addis Ababa, Ethiopia’s capital city with the intention to model the infrastructure and use as evidence to support the key pillars of the President’s Initiative on social factors that affect women and girls in Ethiopia related to WASH. The project will also serve as a model for inclusive and female friendly toilets and hygiene facilities.

Sanitation restores the dignity and confidence of girls in Ethiopia

Among the selected schools for the Ethiopian President’s National Initiative is Atse Neakutole’ab. Established in 1972 in Addis Ababa, Gulele sub city around the area commonly known as Shiromeda. The school strives to produce competent students who will contribute towards Ethiopia’s development agenda.

Atse Neakutole’ab has 673 students and 67 members of staff. Out of total students, 48% are girls. Prior to WaterAid Ethiopia’s intervention, the school used to only have one toilet block with eight cubicles for use by both staff and students.

toilet block


Today, WaterAid Ethiopia in collaboration with the Ethiopian President’s National Initiative have constructed new toilet blocks with ten cubicles and a menstrual hygiene management (MHM) room.

Yematawork Getachew.

Yematawork Getachew, Director of the Atse Beakutole’ab school in a candid moment during the visit to the school. PHOTO | COURTESY

‘I believe students will be happy while coming to school. WaterAid Ethiopia has done here can be taken as an example for other organizations doing similar work,’ said Yematawork Getachew, Director of the Atse Beakutole’ab School.

The project has been efficient as not only did it enhance sanitation facilities of the school, but it also provided access to water, allowing sustained access to water, sanitation and hygiene (WASH) facilities for schoolgirls and disabled. Access to water is part and parcel of good sanitation and hygiene. Without the supply of water, toilets wouldn’t be able to function by themselves. The cleanliness of the toilets will be kept and schoolgirls that make use of this will be happy.

Ato Ashenafi Simon.

Ato Ashenafi Simon, a teacher at Atse Beakutole’ab School poses outside the recently constructed toilets, supported by WaterAid Ethiopia. PHOTO | COURTESY

Ato Solomon, one of the teachers who is also part of the management team says, ‘The toilets are very important as it is also inclusive to accommodate persons living with disabilities.” He added “Girls already face challenges, let alone being a disabled female student. This makes the facility even more useful.’

The teacher also says that the waste disposal facilities for used sanitary pads is in a convenient place, making it easier to dispose the waste without affecting the climate.’

‘The water supply suitability is also the other strength’, Solomon says, and the infrastructure has designated an area for the students of all ages to access drinking water.


Bemenet (15), Nohamin (14) and Meraf (15) are friends who are now at their final year to finish elementary school. Having spent their entire elementary school journey at Atse Nakuto’leab, they all share a common story about the inconvenience of the old toilet at their school. PHOTO | COURTESY

Meraf, a 15-year-old student at Atse Beakutole’ab school remembers an incident when her friend once ruined her dress while in her period, forcing her to go back to her home to clean herself and miss class. Had there been a rest room and fully equipped toilet back then, Meraf says “My friend wouldn’t have missed her class by going back home.”

The three friends said ‘Menstruation has its own stress until you understand what is happening to your body. Sometimes we even feel that it’s a kind of a disease and not a natural process. So, we will try to teach our youngsters about menstruation and how to use the rest room if they need to use it in the future.” 

Yenensh Welde Michael.

Yenensh Welde Michael, Atse Beakutole’ab school’s toilet cleaner gets ready for her cleaning service. PHOTO | COURTESY

Yenensh Welde Michael, having worked as the school cleaner for a year now, she has seen a huge difference in the sanitation and hygiene facilities as it is much easier to clean, very attractive and comfortable for girls in the school. Yenensh and her colleagues, clean both the classrooms and toilets three times a day i.e. in the morning, afternoon and evening. She is happy the school has provided enough cleaning materials. She however believes more awareness and student’s participation is needed to maintain the cleanliness and safety of the sanitation facilities.


To support what the government has started in providing quality WASH services throughout the country, WaterAid Ethiopia developed a concept note to work in collaboration with the President’s Office, Ministry of Education and Addis Ababa Education Bureau in two selected schools in Addis Ababa. Atse Nakutole’ab is one of the selected schools.

This initiative is aligned to the aspirations of Agenda 2063 which visions that by 2063, African countries will be amongst the best performers in global quality of life measures including the provision of basic services including water and sanitation for everyone, everywhere.

The Sanitation Problem: A Glance at Community-led Solutions

Chris Tumwine.

Chris Tumwine on the Streets of Kampala. PHOTO | WATERAID | RUTH MBABAZI

Snapshot on Uganda’s Sanitation

The World Health Organization (WHO) stipulates that improved sanitation facilities should hygienically separate human excreta from human contact.

According to the Ministry of Water and Environment’s Sector Performance Report 2020, Uganda has made progress with access to improved sanitation in rural and urban areas at 78% and 89.1% respectively. However, the use of safely managed sanitation which hygienically separates human excreta from human contact is still very low with rural and urban areas at 7.1% and 39.2% respectively.

Furthermore, 8 in 10 people don’t have a decent toilet, making it significantly difficult to maintain good hygiene. Without decent toilets, many people are forced to practice open defecation which is undignified, unsafe and pollutes nearby water sources.

Amidst it all, a few communities are pulling together to change the situation. 

Facing the Challenge

Provoked by the sanitation crisis at his community in Kamwokya, located right in the heart of Kampala, Chris Tumwine, a community WASH advocate asked, "how do we fix it?"

It was a powerful question. Chris has experienced two sides of Kampala, the one with better sanitation services, and the one that he describes as off-the-tarmac. The latter, where he has spent most of his life, suffers from the impact of a poor sewer system, poor garbage disposal, and flooding.

Armed with willpower and the courage to impact change, Chris joined the Weyonje Campaign, which translates to “clean yourself.” Weyonje is a movement that champions inclusive sanitation and hygiene awareness in communities across Kampala. The campaign is an initiative of the Kampala Capital City Authority and is being supported by WaterAid Uganda.

In an interview with the Uganda Broadcasting Corporation, a local TV station, Chris shared that he joined this initiative to educate people on how to improve their sanitation and hygiene.

Tackling Complacency

Even if Chris has lived in Kamwokya most of his life, certain situations seem almost amusing to him. For instance, on a mission to share more about sanitation and hygiene at a community church in Kamwokya, Chris shared his dismay:

"This is a church sitting on top of garbage… it is soft as if you're moving on a mattress, but a mattress of garbage," he said.

Further, he expressed disappointment in the church’s toilet and explained that there is nothing good about it, or its setting. Almost immediately, Chris and his team of volunteers moved to demolish the hazardous toilet.

Although the church's pastor appeared to agree with Chris, he had reservations.

"It's the right (thing to do), but it's also painful because it was done at a time when I was not ready to construct a proper toilet," the pastor said.

Chris was well-aware of the pastor's sentiments, but according to him, the right thing to do, should not wait.

According to Sserunjogi Charles Musoke, the Mayor of the Kampala Central Division, the issue is complacency.

"People get used to the situation," the mayor said. "And because they get used to the situation, they see no reasons for changing the situation. So, it is our responsibility to go and do enforcement. That is a pastor. He is a leader in society. He should be the first person to talk about proper sanitation." 

The Rise of Weyonje

Through the support of the Kampala Capital City Authority, a bigger Weyonje team was assembled in Kamwokya to help spread the WASH gospel. Although there was a small degree of resistance from the community, the team worked hard to offer sensitization on who they are, until buy-in was achieved.

According to Susan, a member of the Weyonje team, people welcomed the campaign and its objectives. Susan's dream is to have a community where you would look around and not see anything unsanitary. At the end of it all, Susan hopes that Weyonje’s work would reduce on the number of people going to the hospital for preventable diseases like diarrhea.

The Weyonje campaign is a direct reflection of the government's commitment to making public health a priority. According to the mayor, the authority is devoting more budgetary resources towards managing proper sanitation in the city.

"We could not do it alone," said Musoke, "We have partners, and one of them is WaterAid. They are taking me for training as a politician, so that I can enhance and help other politicians to appreciate the importance of good sanitation."

It Takes a Village

To ensure sustainability, Chris reached out to other community leaders like Patrick Mavo aka Ticha Mavo, the founder of Ghetto Research lab. Mavo’s organization develops innovative projects that improve the lives of impoverished residents in Kamwokya while solving environmental pollution. According to him, their organization hires over 400 youth who collect would-be-waste and use it to create jobs and wealth.

"We are creating sustainability in the ghetto," he said. "We work with Weyonje on different projects because we are birds of the same feathers."

Through working with other community leaders like Mavo and government actors like the mayor and KCCA, Chris and the Weyonje team were able to convince the residents of Kamwokya to come together and sign The Kamwokya Sanitation Declaration. It was a declaration to build toilets where necessary, and a commitment to keep them always clean – a significant step towards achieving sustainable urban WASH.

On his journey to impact change in Kamwokya, Chris did not get all the answers, but he learned a critical lesson that would shed light on the road ahead – it takes a village "to fix it."

Fighting COVID-19 Together

Kamwokya is home to more than 6,000 people and is less than half a square kilometre of land. So, it’s easy to see how social distancing and following standard operation procedures can be difficult. However, that won’t stop the Weyonje team from trying.

“In Kamwokya we already have a community WhatsApp group where people share information. This is a good platform that we can use to counter misinformation about COVID-19 that is circulating on social media,” said Chris.

He added that his team carries out house to house community education which aims to teach residents that proper and regular handwashing with water and soap is a formidable defense against the spread of COVID-19.

Lastly, since many homes in the Kamwokya community don’t have quick access to water sources, the Weyonje team has creates makeshift handwashing stations. They fill plastic bottles with soap and water and tie them to the front doors of residents with strings. Through this, the residents can wash their hands properly before entering their homes.

The H&M Foundation

Weyonje’s work is supported by the H&M Foundation as part of WaterAid's Sustainable WASH programme. The Sustainable WASH programme aims to improve access to clean water, decent toilets and good hygiene in a long-lasting way. The programme objective is ensure people at all levels, from the government, to civil society, to the private sector, have the resources and skills they need to play their part in improving access to WASH.