Without planning, urban areas wallow in filth and disease

BIG DANGER: Most of the slums like Katanga have drainage ditches carrying a mass of sewage, rotting garbage and plastic materials. Wassajja says that development of slums cannot be left to government alone, it must involve people with better education and exposure. File Photo

Urban living can be bad for your health -- at least in Uganda. To mark World Health Day tomorrow, whose theme this year is urbanisation and health, the Daily Monitor will run a two-part series, beginning with this story, on the many dire health consequences of the country’s failure to plan its cities, by Evelyn Lirri

On the porch of a tiny mud-and-wattle hut in a slum section of Ggaba, a Kampala suburb, Ms Sarah Namutebi, 29, sits clasping her nine-month-old baby. She looks deeply worried.

Ms Namutebi’s baby, looking frail and dehydrated, has been down with diarrhea for the past three weeks. The baby’s eyes are sunken and the mother is desperately struggling to save its life.

It is easy to see why the child is sick. In front of the one-roomed house runs a drainage ditch carrying a mass of sewage, rotting garbage and plastic materials. The unsightly hodgepodge emits a horrid stench that suffocates the neighbourhood.

This is the reality of life for an estimated 3.3 million of the 5.5 million Ugandans who live in urban areas today.

Effective urban planning and enforcement would improve living conditions and sharply reduce disease. But the population is growing far faster than authorities can plan, hobbled by lack of funding, incompetence and corruption, can keep up.

The result: rapidly-growing mass slums where poor sanitation, dust, lack of proper ventilation, overcrowding and uncollected garbage all pollute and choke the living environment, making urban centres a death trap for dwellers (read a special report on rot of our towns in tomorrow’s Daily Monitor).

The problem promises to get worse before it improves. “Uganda is fast urbanising and if you don’t address urbanisation problems like health, water and infrastructure you will have a catastrophe,” warns Mr Urban Tibamanya, the state minister for Urban Development.

The consequences are already here to see. In Kampala alone, some 40 per cent of the city’s 1.8 million residents live in informal settlements like Katanga, Wabigalo-Namuwongo, Makerere-Kivulu, Ggaba, Kifumbira and Kisenyi.

Records show most communicable and hygiene-related infections break out in these areas, which often are unplanned and lack adequate housing and access to clean water and sanitation.

Intestinal worms, diarrhea and asthma topped the list of the most prevalent diseases in Kampala city between 2006 and 2009. Kampala City Council’s health division says these diseases jointly contribute to more than 80 per cent of the disease burden in the city.

In 2009, 43,434 intestinal infections were registered in Kampala district from common parasitic worms like ascaris, tapeworms and pinworms found in unfiltered water. Acute diarrhea cases totaled 27,694 cases, while persistent diarrhea cases reached 9,717.

In Ggaba mission slum, diarrhea is so common that few there consider it a disease anymore. Rather, it is seen as a normal part of life.

Cholera, another deadly disease usually associated with poor hygiene, had been dropping, from 1,104 cases in the 2006/7 financial year, to just 40 the year after, but the number of cases increased to 74 in 2009. Dr. John Lule, the KCC chief health inspector, said increased public education and awareness on hygiene and sanitation have contributed to this decline over the years.

Respiratory illnesses also are on the rise. According to the State of the World Cities report 2010/2011 published by the United Nations Human Settlements Programme (UN-Habitat), acute respiratory infection cases in Uganda are high in slum and rural areas- with slums and rural areas. Twenty-three per cent of their residents suffer acute respiratory infections, compared to only 14 per cent of residents in urban non-slum areas.

Many of the hygiene-related illnesses arise from poor sanitation. Although latrine coverage in Kampala district stands at 85 per cent, health experts say the access is not even geographically because many slum dwellers cannot afford the Shs100 they are charged to use them. As a result, many end up using polythene bags — commonly referred to in slum parlance as “flying toilets” – to dispose of their waste.

The indiscriminate disposal of human waste, officials say, is the reason underlying perennial cholera outbreak in the city.

Organised developments
Most of these diseases can be prevented by making the environment healthier through proper planning, health experts say.

Organised spatial developments provide for clearly-demarcated plots, roads, sanitary lanes and public open spaces for people to exercise and relax after work. It also sets standards for proper disposal and management of solid waste.

“If you had better planned housing, you could address the problem of infections that are associated with overcrowding and congestion like TB, respiratory illnesses and other airborne diseases,” says Mr Justine Otai, a senior health environmentalist at the Ministry of Health.

Kampala has developed plans in 1919, 1936, 1972 and 1994, but the city has not followed them.
“The problem is that development is moving faster that planning. People are constructing every day, blocking sanitary lanes where drainage system lines are passing. This has had an effect on the sanitation,” Dr Lule explains.

The situation is made worse by the failure of government to provide basic services. Only half of the 1, 400 tonnes of garbage that the city’s residents produce daily is collected, according to Dr. Lule.
The rest stays on the ground where it is a breeding place for rats and mosquitoes, and becomes a source of air, water and insect-borne illnesses. Much ends up in drainage systems, where it blocks water flow and fills up manholes. As decomposing waste seeps into the ground, water sources are contaminated.

Although the city council has a solid waste management ordinance that compels every city dweller to have a proper garbage sorting and disposal system, Dr. Lule admits implementation remains the biggest challenge.
“Enforcement of the ordinance is still a problem because of manpower. At times we are constrained by fuel and limited staff. But also the attitude of people should change so that they don’t dump garbage anywhere.”

Rapid urbanisation has added a millstone in a situation already complicated by lack of a national urban planning policy. Mr Tibamanya, says government is trying to catch up: an urbanisation policy designed to ensure provision of adequate planned housing, water and sanitation facilities for many low income urban dwellers is in the offing.

He adds that the Physical Planning Bill, which Parliament passed in February, will help to address issues like housing and development. For the informal settlements that are already up, Mr Tibamanya says the government will have to find “medicine” for them.
The Public Health Act of 1964 was supposed to help sort out some of the sanitation and environmental health challenges facing the city today. But nothing has come of it. KCC says it’s constrained by resources and staff, but also overwhelmed by the enormity of the problem.

Currently, there are only 12 health inspectors and 22 health assistants for a day-time population of 2.4 million people. These inspectors are also required including to carry out other activities; food inspection, premises inspection, water source monitoring, and factory inspection.

The Act emphasised that every homestead should have a toilet or latrine. However, 12.3 million Ugandans still don’t have access to these facilities, especially in the slums. Dr. Anthony Mbonye, the commissioner for community health in the Ministry of Health, says although there are policies in place, the problem has been lack of implementation.

“You find a household doesn’t have a pit latrine; the head of that household should be prosecuted. But the problem is implementing the Act.” Every now and then we are seeing more cases of epidemic outbreaks as a result of poor hygiene and sanitation, yet it should be decreasing as we go into development.”

Technocrats’ take
Technocrats are pointing mainly to funding as the inhibiting factor in implementing the Act. The Ministry of Health gets only Shs100m for sanitation campaign which is a meager disbursement, according to Dr Mbonye.
Dr. Mbonye says the Act needs to be revised to set harsher penalties for offenders, and also address other diseases like Ebola and Hepatitis E, which are sanitation related. The Act prescribes a mere Shs200 penalty for offences like failure to construct toilets.
While officials are still trying to catch up with old scourges, lack of planning is contributing to the emergence of newer diseases that are likely to become a growing problem in the years ahead – including chronic lifestyle diseases like diabetes, gout, heart disease and cancer, which are related to lack of exercise.
Although the magnitude of non-communicable diseases is not known in Uganda, Dr. James Sekajugo, the principal medical officer for non-communicable diseases in the Ministry of Health, says cases could reach epidemic levels by 2025 if preventive methods are not put in place.

“People in urban areas are eating more pork and drinking beers, yet they are doing less exercise. We are now tackling two disease burdens. In the past, we used to address only infectious diseases, few people could afford meat and beer but now we have to tackle both,” explained Dr. Mbonye.

In part, the remedy for this, he explains, is having the city allocate more land for park and green spaces so that people can engage in physical exercise. But uncontrolled development has laid some green spaces like the Centenary Park to waste, while others are being indiscriminately built up for commerce and housing.

Why is Uganda consistently failing to plan for better living conditions in spite of this threat? Daily Monitor will explore that question tomorrow.


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