Health authorities and local leaders in Bunyangabu District are increasingly turning to improved water, sanitation and hygiene (WASH) infrastructure to reduce infections and strengthen healthcare delivery amid growing patient numbers and longstanding sanitation challenges.
Officials say inadequate sanitation facilities, limited handwashing infrastructure and unreliable access to clean water have for years exposed patients, mothers, newborns and health workers to preventable infections, particularly in overcrowded public health facilities.
The push comes as Uganda continues to face a significant financing gap in healthcare sanitation. The Ministry of Health’s National Micro Planning Handbook for Water, Sanitation and Hygiene in Healthcare Facilities estimated that the country requires about Shs656 billion to establish adequate WASH systems across health facilities.
A 2024 WaterAid study estimated that healthcare-associated infections in Uganda reached 422,000 cases in 2022, contributing to about 43,600 excess deaths annually and imposing an economic cost of approximately $580 million, equivalent to 1.43% of the country’s gross domestic product.
At Kibiito Health Centre IV, Bunyangabu District’s main referral facility, officials say sanitation infrastructure has failed to keep pace with rising patient numbers.
The facility has been operating with only two toilet facilities shared by patients, caretakers and traders from the nearby Kibiito Trading Centre, creating significant pressure on sanitation services.
“Our number of patients has greatly increased, and the available toilet facilities have been inadequate. In April alone, we recorded 382 mothers delivering from this facility, and all these require sanitation services,” said Dr Robert Abiija, the facility’s in-charge.
“We also share the few available toilet stances with market vendors, which has made them fill up regularly. The facility has been spending a lot of money every month on emptying and maintenance,” he added.
To address the challenge, IRC Uganda this week commissioned a five-stance waterborne toilet facility at the health centre worth Shs43.7 million.
The facility includes separate sections for men and women, with the female wing comprising three stances and a bathroom to support menstrual hygiene management, while the male section contains two stances and a urinal connected to running water.
Dr Abiija said the project would significantly improve sanitation standards and infection prevention at the facility.
“This facility is going to greatly improve sanitation and infection prevention at our health centre. We appreciate IRC for responding to our urgent need,” he said.
Kibiito Health Centre IV receives about 1,500 outpatients each month in addition to hundreds of maternity admissions.
Ms Justin Namara, a nursing officer at the facility, said sanitation pressures had become increasingly difficult to manage.
“We previously had only two latrines serving all patients and caretakers. The situation was becoming difficult because of the high patient load,” she said.
According to Namara, the maternity ward alone handled 382 deliveries from 550 admissions in April, further straining the ageing sanitation infrastructure.
“The new toilets are better designed and easier to maintain. This is going to improve sanitation and the experience of patients visiting the facility,” she added.
At Rwagimba Health Centre III, which serves between 900 and 1,000 outpatients monthly, officials reported similar challenges.
Facility in-charge Josepha Kasule said the old pit latrine could no longer adequately serve the growing population seeking healthcare services.
“We are happy we now have an improved toilet facility because the old one was not enough for the number of patients we receive every month,” Kasule said.
However, he warned that limited access to water remains a major challenge.
“We depend on rainwater harvesting, but during the dry season water becomes scarce because the nearest water source is far away. These improved sanitation facilities require adequate water to function effectively and sustainably,” he said.
Bunyangabu District, which was carved out of Kabarole District in 2017, has 18 public health facilities, including one Health Centre IV, 12 Health Centre IIIs and five Health Centre IIs.
Over recent years, the district and IRC Uganda have implemented WASH projects across several health facilities, including the construction of incinerators to improve medical waste management.
Mary Ayoreka, IRC Uganda’s Regional WASH Officer, said the investments are aimed at strengthening sanitation standards in line with Ministry of Health guidelines.
“Quality healthcare cannot be achieved in an environment that exposes patients and health workers to infections,” Ayoreka said.
“These sanitation facilities are intended to improve hygiene and restore dignity for communities accessing healthcare services.”
She said the facilities were designed to accommodate women, children, older persons and people with disabilities, while strategically positioned handwashing stations would help reduce the spread of infections.
Bunyangabu District Health Officer Richard Obeti said sanitation and hygiene remain critical indicators of healthcare quality.
“When people come to seek healthcare services, they look at all parameters, including sanitation and hygiene,” Obeti said.
“With these improved facilities, we are confident the quality of healthcare is going to improve, and more people will feel comfortable seeking services.”
Obeti said the district’s next priority is extending reliable water supplies to health facilities, particularly those located in hard-to-reach areas.
He added that despite recent improvements, Bunyangabu still lacks a district hospital and continues to rely on Kibiito Health Centre IV as its main referral facility.
“The health centre is overwhelmed by the increasing number of patients. We appeal to the government to consider elevating Kibiito Health Centre IV to hospital status,” he said.