COMMUNITY LEAD TOTAL SANITATION (CLTS) APPROACH

 THE COMMUNITY LEAD TOTAL SANITATION (CLTS) APPROACH
Following triggering of villages on CLTS as a new approach to improve households sanitation in the community

This approachs aims at  having ODF (open defecation free) villages. A number of villages in Pader District, North Uganda, were triggered and follow up has been done to see the community response and progress to this approach. The results are very positive: indeed it is quite amazing to assess that 80% of the village households have constructed a local pit latrine in their households and they are now using them with provisional hand washing facility (tipi tap) which they also constructed. This really has helped population to reduce communicable, especially fecal-oral ,diseases by 74% and hand washing increased by 47 % according to the nearby health facility's report over the last two moths when CLTS was carried out in the area. The photos below show a number of follow-up visits to those villages and to households who were triggered and provided with guidance and skills on how to construct pit latrines and maintain them.

CLTS follow up in the community: in the middle is Geoffrey with the team from the sub-county and the owner of the latrine, without the shirt, as he is working on his latrine.

CLTS Follow ups to attain ODF(open defecation free) status in this rural community.

Hand washing significantly reduces diseases burden and Geoffrey is checking the technology used in the tipi tap in a certain house. Below  he is giving health talk with key health messages to a mother who is the owner of the household on how to use sanitary facility, why they should use it and all the benefits associated with it.

FOOD HYGIENE AND SAFETY IN PADER MARKET

FOOD HYGIENE AND SAFETY IN PADER MARKET

DO WE REALLY BUY SAFE FOOD FROM THE MARKET?!

 

In my visits to the market in Pader town, North Uganda, on several occasions, I have found a situation characterized by poor storage, poor health conditions of the food handlers, dirty selling environment and poor sanitation in the market

 

Posts above and below show Geoffrey conducting Heath Education to the market vendors in

 Pader market

 

What about the sanitary facilities that the vendors are using? The Town Council authority has endeavored to construct VIP latrines in the market for use, so let's see what is happening in the latrine.. Is it being used well??

It looks like as a very nice latrine, but what about inside? Let's see...

The post above shows the nice latrines constructed in the market for public use; however, below is the floor of the above latrine: see how dirty it is! Feaces everywhere and nowhere to step to enter the latrine! What is the problem? What people are not using these latrines properly? Is it due to human attitude??

I indeed have made an attempt to sensitize them in order to use and maintain the latrines properly, I hope for a change! I will pay back visit in two weeks time to see if there are changes and will continue to help sensitize these community members again in the future.

Personal hygiene at school is important!

On many occasion, personal hygiene in schools has been neglected both by pupils and by teachers. For this reason, I took my initiative to visits some schools within my town to assess the status of school-going children on personal hygiene.

Do you know what the findings are??

Primary school pupils do not know how to keep themselves hygienically, especially with regard to hand washing. 

With the initiative I made, I was able to sensitize Primary School pupils of Piapir Primary School in Pader District, North Uganda, on personal hygiene. This will help to reduce the spread of communicable diseases among primary school pupils, such as water wash diseases and many others. I am planning to visit other schools and pass them the same health message. Children are receptive to these messages and it is important to teach them about hygiene topics since they are young. In many cases, once they receive the messages, they can also be able to spread them themselves in theirs families, contributing to health promotion.

 

The picture above shows Geoffrey conducting health education to pupils in Paipir Primary school, Pader District.

Efforts to make water safe for community consumption!!!

Water is life, and people want their life to be safe.. Is the water you are drinking safe?!

Let's find out feasible solutions to make water safe for community consumption in rural areas, since it's the only water source available in the villages!

The picture above is taken in Gweng Otiri village, Latanya sub-county, Pader District and it is the only source of water in this village. It shows children drawing water for drinking and other domestic use from an unprotected well, which is shared by animals. This open well is exposed to storm water, fecal matters and many other risks of contamination, causing water-borne diseases.

What about in the other villages, is it the same situation?

Yes, in some other villages, the population has the same problems and, according to my visits in Atede, Onyon, Lugede, Luzira villages among many others in Pader, I have found out that in most of these villages people draw water from streams, unprotected springs and wells for home consumption/use.

Let's look at Atede East village, in Awere sub-county: the logs are laid on top of an unprotected spring to give provision for standing and drawing water.. How do you expect this water to be safe for drinking? There is contamination from storm water and other sources.

 

                          

Below is  a woman drinking water from an unprotected source, the same where Geoffrey took sampling for testing. This confirms once more that the community of this village (Onyon) uses this stream's water for drinking without any treatment measures.

                            

What can be done to improve the situation in the meantime in  this community?  

Geoffrey has made an  attempt to improve on the situation, while waiting for the drilling of a borehole in this village. He has taken initiative by:

1. Conducting Water Quality Testing, surveillance and monitoring.

The picture above shows Geoffrey sampling water for testing from Gweng Otiri well.
 

Above he is sampling from Lugede stream, Lugede village.

The photo below shows Geoffrey sampling water from the Onyon stream, Onyon Village for water quality testing and monitoring.  

 

Geoffrey sampled water for testing also from the unprotected spring in Atede village (see photo above of the well with the loggs). 

2. Community sensitization on different ways or methods of water treatments. Filtration, settlement, boiling and chlorination by use of water guards and aqua-safe tablets at house holds level are all recommended practices.

With support from Water Office Pader, which provided Geoffrey with water quality testing kits, consumable and laboratory, he was able to conduct the test and give a feedback to the concerned communities with proposed solutions to their problems.

The results of the water quality testing of these water sources were very negative, as they showed numerous "e-coli  forms counts", meaning that the water is contamined. According WHO standards, the e-coli should be zero; for Uganda standard, a value 1 to 3 can still be considered as consumable or acceptable. 

The picture below shows Geoffrey doing water testing in the laboratory, in Pader Water Office (E-coli test).

The picture below shows Geoffrey testing for PH and conductivity of the sampled water from the visited water sources from different villages.

The photo below shows Geoffrey conducting water test for turbidity of the sampled water.

What were the results for the water testing?

Out of the ten (10) water sources which were tested from different water points in different villages, only one (01) gives a result of 10%, meaning that the water of this water point is recommended for human consumption, according to Ministry of Health of Uganda and to WHO standards. No test gives a result of 0%, which is recommended for consumption.

The picture below depicts Geoffrey reading and recording the results in the Water Office, Pader District.

The picture below shows sampled results indicating numerous e-coli in the water tested.

Also the photo below shows the result of water quality testing from one water source which has  numerous e-coli counts forms. All other sources have the same results however the counts varies, the yellowish round particles are the e-coli which have developed after incubation and indicate fecal matters in the water.

Now that the problem is identified, how can we solve or improve on the situation??

As way forward to this problem, Geoffrey decided to independently visit four villages where he had sampled water for testing in order to provide the population with the results of the water tested and to sensitize them on the health-related issues, with a view to addressing  the problem in the community using these infected water sources. More specifically, the sensitization focused on the following advices: 

• to boil water before drinking or to use other household water methods, like chlorination through water guard; 

• to identify and use different water pointes for animals, in order not to share the same points with animals; 
• to always use pit latrines, rather than defecating in the bush, so that fecal matters should not contaminate their open water sources; 

• for the community who are using streams and rivers, they should do specific zoning, i.e. making separate points for different purposes: drinking points, washing points, and identifying water points for animals. This will reduces the contamination rate of the streams and rivers.

Not only unprotected or open water sources.. let's look at what happen at the boreholes!

At the same time it is important to preserve the protected sources of water, which are the boreholes. Sometimes boreholes are built but afterwards the community lacks the skills or financial ressources to maintain them properly. This problem has encouraged Geoffrey to carry out visits at the boreholes in three villages within Pader town council. During these visits, meetings were held with the boreholes committees in these villages and sensitizations were provided to them on the operation and maintenance of the boreholes. This was aimed at increasing their knowledge and skills to properly maintain the boreholes, avoiding contamination and breakdown of boreholes which later would lead to contamination and disease outbreak in the community.

The picture above shows Geoffrey guiding the water user committee of Bolo Dam Village, Lagile Parish, Awere Subcounty on operation and maintenance of boreholes in their community.

Geoffrey and the water sources committee of Ajobi borehole, Ogago Parish, Pajule subcounty.

Water source committee of Dago Dwong Village, Ogom planning to improve their borehole after the sensitization received.

Community sensitization on hygiene and sanitation

Community sensitization on household hygiene and sanitation in the villages in Pader district, North Uganda

 

 The importance of sensitizations

Community sensitization in rural communities on health and sanitation is very important because it creates awareness in the community on the benefits of having, using and maintaining sanitary facilities, like latrines, in the homes. Not all the population in this area has latrines in their houses, and they use open spaces for defecation. Through the sensitization the community members can be aware of methods needed to promote health in their households as well in the entire community. They also become aware that they have important roles and responsibilities for the construction of these sanitary facilities in their households for their own benefit. This underlines the difference from the time of emergency, when most of this population was displaced in camps and facilities, like latrines, were constructed by different NGO's in the camps for community use. 

When households members use latrines and drink safe water, they avoid suffering from water borne and sanitation diseases which still represent a common problem in Uganda, especially in Northern Uganda, which was the area affected by insurgency in the 80s and 90s. The water borne diseases can be controlled and prevented by good hygiene practices, good household sanitation and drinking safe water.

By sensitizing community to construct their own sanitary facilities and have ideal home steads, they will feel the ownership of these actions and related results and the individual household members will be able to use and maintain the facilities well. It is our role, as health workers, to make the community aware!!!!

During the sensitization sessions, the following topics are discussed:

• The advantages and benefits of having an ideal homesteads, including homes with latrines, hand washing facilities, bath shelters, refuse pit, protected water source, drying rack, animal house, and birds houses;

• The negative consequences of poor hygiene and sanitation on health;

• Skills and knowledge on sanitary facilities construction like latrines, refuse pit, protection of water sources and many others; 
• maintenance of water sources, in order to establish the safe water chain; 

• Formation of village sanitation task-forces, as well as establishment and enforcement of by-laws.

The photo above shows the community in Wii Raa village, Laguti sub-county, Pader district, selecting the sanitation task-force at village level for household sanitation improvement, guided by Geoffrey Kilama, Health Inspector in Pader District. The selected members are the ones standing on the left hand side of Geoffrey.

The photo above shows Geoffrey Kilama holding community sensitization meeting, standing amidst community. The man talking is a community member providing his ideas on how to improve sanitation especially latrine coverage in the village. 

The situation on sanitation in Northern Uganda

The target of Government action on sanitation is all the house holds, villages, parishes, sub-counties and districts in Uganda have an ideal home steads. The national report on sanitation shows a latrine coverage of only 41% in the country, which is a poor indicator, calling for further action. This situation is particularly serious in villages of Northern Uganda, an area which was affected by insurgency and civil war for a number of years in the 80s and 90s. As a matter of fact, in this area in the past years, there has been a series of disease outbreaks, such as cholera, hepatitis E, polio and others, due to poor hygiene and sanitation.

 The situation in this village

As per the district report, district latrine coverage was at 46.8% only in 2013. When Geoffrey was in this village, there were only 17 households with functional pit  latrines out of  84 house holds, which account for 20.2% latrine coverage only in this village. This indicates that 78.8% of the households in this village defecate in the bush; this feace (fecal matters) is then washed to water points and contaminates water sources, where people draw water for domestic use. There are many water points in the villages, such as unprotected well, springs, streams, rivers, ponds and many others, which are likely to be contamined in this way. As well, flies carry these fecal matters and bring them to peoples houses, thus contaminating food, which results into health problems such as diarrhea and other more serious diseaase, leading to economic loss and sometimes to death. 

The objectives of sensitization is to create awareness on the benefits of using sanitary facilities like latrine in the houses and the consequences of not using them. The latrines should be constructed as guided by the Ugandan law "Public health act, rural sanitation rule".

Sensitization sessions

As Geoffrey's effort to improve on sanitation in order to prevent diseases related to poor sanitation, he managed to visits 6 villages over the last two months in order to provide them with health education sessions on the prevention and control of hygiene and sanitation related diseases. 

The communities were encouraged to use different methodologies and approaches to improve and increase sanitation coverage at household level, including PHAST (participatory hygiene and sanitation transformation), CLTS (community let total sanitation), HIC (Home improvement campaign) and Community meetings. 

The aim of these approaches is to make the village "Open Defecation Free" which means: nobody in the village who declared ODF should defecate in the bush. As a follow up, the number of pit latrines constructed in the village are counted and compared to the number of households. 100% latrine coverage is the target ratio to achieve.

Steps involved in CLTS are community mobilization and village triggering which includes mapping (as shown in the picture below), "walk of shame" for those still defecating in the bush, food and water bottle demonstration, shit calculation, medical expense calculation, problem identification and analysis, developing village sanitation work plan, formation of village sanitation task force and lastly formation of by-law and follow up of triggered villages. 

The photo below shows community drawing their village map in a participatory way and Geoffrey is looking at what they are identifying in their villages as problems in relation to poor sanitation, which need to be addressed.

The photo below shows community drawing the map of their village locating all the negative factors that are found in the village, including identification of  household without latrines, and later giving way forward to address the situation to make sure all those households have pit latrine within the agreed period of time.

What is your effort as health worker, leader, stakeholder or community member to combat this controllable and preventable sanitation situation in our communities in order to reduces the morbidity and mortality? Let's work together and be committed citizens to promote health in our communities!!!!! Speak out and engage yourself in improving health situation within our communities, its our duty!!!

Sensitization of youth on HIV/AIDS prevention and control in Pader

Many people take it for granted that all youth knows how to use condoms and they go on telling youth to use it. But is this enough? There is also need to sensitize them on how to use condoms!!!

My findings during sensitization on condom use among youth clearly indicate that many of them do not know how to use condoms correctly and consistently. Even besides that, they feel shy to go and pick free condoms at the health centers for use, because of fear of stigmatization. So let us all be aware of this issue and talk to youth to encourage them to get this free service from the health centers.

My fellow health workers, government and different stakeholders, let's fight HIV/AIDS which is rampantly increasing among youth in Uganda. Together we can help people be protected! HIV is real and it is still a big threat to our nation. By joining efforts we can save our fellow mates from this infection.

 

Above and below is Geoffrey demonstrating how to use condoms during a sensitization to youth in Pader, North Uganda.

The photo below shows Geoffrey giving health talk /education to youth on HIV/AIDS preventive and control measures in Pader youth center. This sensitization was aimed at helping increase youth's awareness on the ways of preventing and controlling HIV/AIDS spread and infection.

Let us save our young generation by making them aware of the problems so that they become the change agents. Young people are the future of the nation, let's protect them and save our nation.

You have a role to play....act now!!!!

What is your effort toward HIV prevention and control in your community or country?

Refuse management

Refuse management

Waste management is still a big threat in Uganda.. But did you know that waste is useful?!

Improper waste disposal is unfortunately a common problem in Uganda, both in rural and urban areas. It causes a number of negative consequences, such as breeding of vectors (e.g. mosquitoes) which carry diseases, water/ground contamination, fire outbreaks, road blockages, foul smells, unsightly environment and general environmental degradation, which in turn contribute to global warming, among others. At the same time this causes economic loss at household, local, national and international levels in term of expenditure for disease treatment, disinfestations, and efforts for cleaning and improving the environment. Yet this situation is not being adequately addressed, as there is absolutely little support from both the local and national government, as well as from communities at large to tackle the problem.
Unfortunately there is no clear policy about waste management in the country, or, if some regulations are present, they are not being enforced as they should. Also people are still quite ignorant about it and are not properly guided on waste management.

This situation is producing gaps in waste management in Uganda - our beloved country! - which is rich of a number of environmental resources which should be properly protected for the well-being of its people! Especially in rural areas, communities often rely on a delicate balance of natural resources and they should be advised on how to better protect them.

Waste can be of your benefits, manage it well and use it!
Despite the problems caused by waste management, we often forget that indeed waste can be used for other purposes bringing about benefits. Recycling waste, which is not a common practice in Uganda, is a very useful activity, applied in several countries worldwide. This leads to reduction on the volume of waste produces and the re-use of waste for products like fertilizers, bio gas, paper, metal and many others for the benefit of the community.

Waste can be well recycled when the following steps are observed:

• Carrying out waste sampling and analysis

• Ensure waste segregation, like biodegradable and non biodegradable or infectious and non infectious wastes which will give ways for proper storage. 
• Ensure proper treatment and distribution for re-use
•  Apply proper waste collection, storage and disposal

Ways forward to improve on the situation

Waste management involves some technicalities but it also includes principles of general knowledge on environmental protection, which can be easily put in practice by the people, when they are properly informed. Unfortunately at the national and local levels, not enough attention is given to this problem and communities, local authorities and government continue to keep the issue of waste management out of their priorities. This has made the magnitude of the problem to increase, resulting in the many problems mentioned before.

However, besides promoting waste recycling, there are other different ways to address the situation at the general level: 

• Conducting mass sensitization of the communities to change their attitude of indiscriminate disposal of waste through behaviour change. They can only change when they know the disadvantages of indiscriminate disposal of waste and the benefits of safe waste management and recycling. .. Let’s try it, it has worked in other countries!

• Building the capacities and knowledge of the public health staff especially in the local districts by providing them with more technical advises on waste management, e.g. the correct steps in waste recycling and the benefits of the recycled products for the communities, so that they can be fully equipped to conduct behavioural change campaigns... Knowledge is power!

• Increasing the number of public health staff at district level in order to strengthen the enforcement of public health acts and improve the entire management of waste in the local community.. If we are more, we can do a better job!
• Strengthening and implementing the policy on waste management, which needs intervention from both the technical, policy and enforcement officers.. everyone is needed!

Now, a question!

How can we improve on this situation in other ways?  And can you give us other examples of recycling waste or un-used stuff?  Share your ideas!

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The photo below shows waste damped in the middle of town (the market area) in Pader town in North Uganda.