Water, sanitation crisis hits Tooro, Rwenzori health units

Health facilities in Tooro and Rwenzori sub-regions are facing a water, sanitation, and hygiene (WASH) crisis, with a combined funding gap of more than Shs30 billion, undermining efforts to provide safe, dignified, and quality healthcare.

Despite WASH being critical for infection control, maternal and newborn health, and occupational safety, many healthcare facilities in the two sub-regions continue to operate without access to safe water, functional sanitation systems, or proper medical waste disposal mechanisms. 

In terms of district-specific investment gaps, Kasese needs Shs15.5 billion, Bundibugyo Shs4.66 billion, Bunyangabu Shs2.99 billion, Kamwenge Shs3.97 billion, Kitagwenda Shs1.87 billion, Kyegegwa Shs2.26 billion, and Ntoroko Shs1.17 billion.

These funding shortfalls directly affect service levels in health facilities, which are assessed under four WASH access categories: no service, limited service, basic access, and advanced access.

Most facilities in the two sub-regions fall within the basic or limited categories, with no facility achieving the advanced level, which the World Health Organisation considers necessary for safe and reliable healthcare delivery. In Kasese District, of the 106 facilities assessed, 23.6 percent had no access to water, 20.8 percent had limited access, and 55.7 percent had basic access. 

In Kabarole District, 21.3 percent of the 47 assessed facilities had no access to water, 12.8 percent had limited access, and 66 percent had basic access, with none meeting the advanced level. 

Bunyangabu District recorded 4.3 percent of its 23 facilities with no access to water, 4.3 percent with limited access, and 91.3 percent with basic access. Bundibugyo had 26.9 percent of its 26 facilities with limited access to water and 73.1 percent with basic access. 

In Kyenjojo, 7.7 percent of the 26 facilities had limited access to water, while 92.3 percent had basic access. Kyegegwa District, with 17 facilities assessed, had 5.9 percent with no service, 17.6 percent with limited access, 70.6 percent with basic access, and only 5.9 percent with advanced access.

Access levels

In Kitagwenda, 45.5 percent of the 11 facilities had limited access and 54.5 percent had basic access. Ntoroko District had five facilities assessed, with 40 percent having no service, 20 percent limited, and 40 percent basic access.

According to Mr Martin Watsisi, the regional WASH officer with the International Water and Sanitation Centre (IRC), the persistent shortfalls stem largely from poor prioritisation and a lack of dedicated WASH funding in the health sector. 

“The problem is partly due to WASH not being prioritised. In healthcare, there is no dedicated budget for WASH. Although 30 percent of the primary health care (PHC) fund is earmarked for public health issues, it is not specifically allocated to WASH,” he said. 

He added: “WASH services are essential in healthcare. A facility cannot function properly without adequate water and sanitation infrastructure.” 

“Unfortunately, many health centres still lack proper facilities, putting both staff and patients at risk. It is unacceptable for a patient to acquire a new infection due to poor hygiene, or for a health worker to get infected while on duty,” he added. 

Mr Watsisi emphasised that bridging the WASH funding gap is also essential for meeting Sustainable Development Goals (SDGs) 3 and 6, which focus on good health and access to water and sanitation for all. Some progress is being made. 

In Bunyangabu District, IRC, in partnership with the Church of Jesus Christ of Latter-day Saints, recently commissioned four VIP latrine blocks at Kabaate and Kabonero health centres and at Rubona and Kibiito primary schools, at a cost of Shs176 million. Each latrine has five stances and includes access to clean water, incinerators for safe disposal of menstrual hygiene products, and inclusive features for pupils with disabilities. 

Despite such interventions, medical waste management remains a serious concern across the region. In Kabarole District, only two functional incinerators exist—at Kijura Health Centre III and Rutete Health Centre—both built with IRC support. A third, funded by the government, is under construction at Kichwamba Health Centre. In Bunyangabu District, two IRC-constructed incinerators currently serve 20 health facilities.

Shortage of incinerators

Dr Steven Kalyegira, the Kabarole District health officer, said due to the shortage of incinerators, many health facilities are forced to transport their medical waste over long distances or dispose of it unsafely, putting the environment and public health at risk. He stressed that proper waste disposal is as vital as access to clean water, and that without it, the region risks reversing the gains made in public health. 

Experts and local leaders are calling for increased political commitment, ring-fenced budgets, and sustained investments to ensure that every health facility meets the minimum standards for water.