By the time many Ugandans reach old age, they have spent decades building families, communities, and livelihoods. They have raised children, cultivated land, contributed to the economy, and helped shape the country. Yet for many of them, one of the most difficult and humiliating parts of old age is something most people take for granted; using the toilet.
Many families, communities, and policymakers fail to consider the basic needs of older adults in the design of homes and public infrastructure. According to national sanitation data, pit latrines remain the dominant form of sanitation, particularly in rural areas where most older Ugandans live. While these facilities serve millions of households, they are largely designed for people with healthy joints, good balance, and full mobility.
Pit latrines by their nature require users to squat. For younger people, this may be a minor inconvenience, if at all. For the elderly living with arthritis, joint pain, muscle weakness, impaired vision, or other age-related conditions, squatting can be physically painful, humiliating and sometimes impossible. Architects are not doing nearly enough to make toilets as elder-friendly as possible. The problem is not merely anecdotal. Researchers have been documenting it for years.
What research says
In 2014, a team of researchers led by Sarah Ben Jones published a landmark study in the journal BMC Public Health examining sanitation conditions in Kampala’s informal settlements. The study, titled “We Is Not Happy Until We Have Safe Clean Toilets,” found that elderly residents were among the groups most disadvantaged by poor sanitation infrastructure. Participants described fears of falling, difficulties navigating slippery paths to toilets, poor lighting at night, and challenges using facilities that demanded physical strength and balance.
The researchers concluded that older people faced unique barriers that were often overlooked in sanitation planning. While the study focused on urban informal settlements, its findings resonate strongly in rural Uganda, where pit latrines are often more basic and access paths less secure. Some families have recognised the problem and have developed their own solutions. Across Uganda, it is increasingly common to find improvised toilet seats made from wood or concrete, built over pit latrines. Their purpose is straightforward; to allow older people to sit rather than squat. Families understand the problem because they see it every day. What is missing is broader institutional recognition. The burden of creating accessible sanitation should not rest entirely on individual households.
Kenya’s efforts
Other developing countries have begun taking steps in this direction. In neighbouring Kenya, sanitation organisations have increasingly promoted what experts call “inclusive sanitation”; the idea that toilets should be designed for everyone, including older people and people with disabilities. WaterAid-supported projects have demonstrated that relatively simple additions such as handrails, ramps, raised toilet seats, wider entrances and non-slip flooring can significantly improve accessibility without substantially increasing construction costs.
State of affairs
I believe that local governments, development agencies, health professionals, architects and community leaders all have a role to play. Building standards could encourage the inclusion of accessibility features in household sanitation. Community health programmes could educate families about affordable modifications. Development partners could support pilot projects demonstrating accessible pit latrines in rural communities.
Most importantly, older people themselves must be included in the conversation. Too often, sanitation policy is designed without consulting those who face the greatest challenges. Elderly Ugandans understand better than anyone the obstacles they encounter every day. Their experiences should guide future solutions. A society reveals its values through the way it treats its most vulnerable members. Older people may no longer occupy the centre of economic or political life, but they remain entitled to safety, dignity and independence.