As the world grapples with the COVID-19 pandemic, countries, including Uganda, have adopted various measures to prevent its spread. The Ugandan Ministry of Health, in line with guidelines from the World Health Organization, has promoted regular handwashing with water and soap as one of the essential precautionary measures that the public should take, as handwashing kills the virus and therefore helps prevents its spread.

But regular handwashing requires regular access to and availability of clean water. According to the Ugandan Ministry of Water and Environment, 34% of villages in Uganda are currently living without adequate access to clean water. In many communities, water infrastructure is absent, insufficient, or dilapidated. One therefore wonders, how is regular hand washing to the required standard possible for all?

In fact, as a direct result of inadequate access to water, handwashing in Uganda is not consistently practiced. The government reported that in 2017-2018, only 36.5% of rural households had handwashing facilities with soap and water. To ensure all Ugandans can help prevent the spread of COVID-19 by practicing regular handwashing, the government needs to take quick steps to improve water access while also expediting systemic changes to address the access gap comprehensively.

Water for health

Water is a human right, that entitles everyone to sufficient, safe, acceptable, physically accessible, and affordable water. As COVID-19 is making apparent, the right to water is closely linked to health. For COVID-19, handwashing is a critical measure to prevent contracting and spreading the virus, but doing so requires accessibility, availability, and affordability of water. Access to water is also essential to prevent other diseases such as diarrhea, cholera, and dysentery.

The Government has an obligation under international law to provide access to safe and clean water for all. Sustainable Development Goal number 6 also calls for universal and equitable access to safe and affordable drinking water by 2030.

In many households both in rural and urban areas were already struggling to get regular clean drinking water even before the pandemic so it must be even harder getting regular water to wash hands. Such challenges associated with accessing water do not only make the fight to combat pandemics like the corona virus hard, but they also keep these vulnerable groups in a cycle of poverty.

They struggle to meet their sanitation needs hence declining health, lose out on education and are unable to participate in paid economic activities because care roles like collecting water take up their time. Generally, they are unable to tap into opportunities that would improve their lives hence leaving them in a cycle of poverty and inequality.

A woman fetching stagnant water in front of her house in one of the Kampala slums. Photo credit_ Julius Kasujja (1).jpg

Access to water in urban environments

In Kampala for instance, the water peak demand per day is 300 million liters of water, however, only 240 million liters of water is available per day. To bridge this shortfall National Water and Sewerage Corporation (NWSC) is constructing a 240 million liter per day capacity water treatment plant in Katosi to the East of Kampala. But because this project is underway it leaves many households water stressed as the country grapples with the COVID-19 pandemic. 

In urban households, some people have community water sources that have quality water but at a fee. In most cases, people will pay for just the minimal amount they need for drinking and other essential uses like cooking. At this critical time when they are presented with the greatest need to wash their hands regularly, most families cannot even afford enough water for drinking, cooking, and washing. The stay at home lockdown has meant prioritizing the minimal income. Any water obtained at the household level is sparingly used for drinking and cooking food as well as cleaning dishes. Applying the minimum standards of washing hands after visiting the toilet is less likely in such households let alone washing hands regularly. This further exposes households and their members to COVID-19 and other hygiene-related diseases.

In contrast, there are some of us privileged to afford running tap water within our households and other alternative sources like rainwater harvesting and storage. Undeniably, our struggles cannot be compared to those with no nearby access, but this does not mean that committing to the frequent hand washing practice has not come at a cost. Some households in these categories have also had a fair share of exorbitant water bills given that many have been providing water to a large number of household members during the lock-down. Some of these on the piped water system requested for waiving of water fees during the COVID-19 lock-down. National Water and Sewage Corporation recognized the legitimacy of their concern but could not waive the water fees.

According to Dr Eng. Silver Mugisha, the MD NWSC, the price regime at hand is already characterized by an average value that is way below cost recovery threshold.Currently, the average production cost (excluding capital development expenditure) is about UGX 56 ($ 0.01496) - per 20 litre jerrycan. The NWSC price structure (excluding VAT) for low income/urban poor is UGX 21 ($ 0.00561)- per jerrycan and for domestic households with private connections/institutions at UGX 68 ($ 0.01816)- per jerrycan). This suggests that the surplus realized from other users covers the subsidy provided to the poor.

As an alternative, the corporation has deepened customer engagements encouraging them to prioritize payment of water bills for the service to continue rather than applying their approach of water disconnection for nonpayment. To further aid the situation especially for people on the periphery of the network which at the moment receives intermittent supply or no water at all, NWSC partnered with Mobile Telephone Network (MTN) and Roofing’s Uganda Limited and provided 100 public water points to Kampala water stressed areas to benefit 30,000 households as a short term relief.

Accessing this water is however at a fee of UGX 25($ 0.00668) per 20 litre jerrycan. While the effort in making this water available was welcome, it targeted a few already on the piped water system in the urban areas and only those with the capacity to meet the cost of water.

A South Sudanese refugee fetching water. Photo by Julius Kasujja .jpg

Access to water in rural areas

Accessing water means walking long distances to draw it from the rivers, springs and, ponds. Even in areas such as refugee settlements where several agencies have set up water projects, the population continues to be water-stressed due to the high numbers of refugees who must share these water sources with the host community. According to a UNHCR 2020 quarter 1 performance snapshot, refugees received 16litres of water per person per day against the standard 20litres. The gap in water provision is attributed to limited resources and reach by the different agencies involved. According to UNHCR, the 2020 refugee response requires $ 827M to ably respond to the needs of refugees however, the response remains 79% critically underfunded.

In a bid to continue providing water amidst the funding challenges, agencies like Oxfam have invested in more sustainable and cost-effective ways to ensure families have the water they need. They have set up hybrid water systems which rely on solar power to deliver water. These systems according to Oxfam are part of their preparedness plan to build the resilience of these communities but they are also a demonstration of a cost-effective way of ensuring sustainable water to communities. In some areas, Oxfam has handed over these systems to the Office of the Prime Minister, the Local Government and where available Utility management bodies like NWSC, and the area water boards.

This is with an understanding that these bodies can sustainably manage these water systems ensuring that the refugees and local people would be better prepared to manage the challenges ahead such as health pandemics. These and many innovative approaches by other agencies have reduced the water stress on these communities. However, with the limited resources and reach, there is need for the Government to pick up on such interventions and others that work for scale up, to ensure that all communities can access clean and safe water.

A burden for women and children

The demand for water has also increased women’s and children’s workload and vulnerability. While the burden of water weighs on everyone, it weighs disproportionately on the grounds of gender. The role of collecting water at the household level in many communities is socially constructed for women and children. They trek long distances and sometimes double trips to get water for household use including handwashing. This is an extra load to the increased domestic care work they have had to take on during this lock-down.

Collecting water from far away sources exposes them to risks as they become targets of sexual violence and attacks. There is also an opportunity cost, risk of disease, and generally dis-empowerment. For example, the children in these vulnerable households are spending long hours during this lock-down trying to get water for the family other than catching up on their education through the home study measures that the Ministry of Education put in place.

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The COVID-19 response

The above challenges related to accessibility, affordability, and availability of safe water especially for the vulnerable households show the prevailing inequalities within our societies and the critical need for a sustainable long-term solution to water. Importantly, they reveal that while the government has put in an effort in sensitizing the public on handwashing, the response measures put in place have not prioritized boosting the availability, accessibility and affordability of water to support handwashing towards preventing the spread of coronavirus.

The May 2020 Budget Monitoring and Accountability briefing paper by Ministry of Finance, Planning and Economic Development indicates that while public health experts have advised washing hands at least 20 times a day to prevent the spread of COVID-19, 51% of the urban poor suffer limited access to safe water. One of the recommendations was for the Ministry of Water and Environment, and National Water and Sewerage Corporation to devise a more proactive plan to provide access to basic water and sanitation facilities either free or at minimal cost.

While from the Financial Year 2019/2020 supplementary budget, allocations were made to various Ministries including the Ministry of Health, the Office of the Prime Minister Support to the vulnerable , Kampala City Authority (KCCA) and the Local Government, only KCCA budget estimates for COVID -19 response had proposed an allocation of UGX 3,355,675,667 to water and sanitation. Although KCCA was eventually allocated two billion shilling out of UGX 30,181,535,267 requested for, there is no clarity on how much of this is being put to the provision of water.

In addition, the Ministry of Health supplementary budget was increased in Financial Year 2019/ 2020, nonetheless the allocated funds were to be spent on the salary of staff to be recruited, allowances to staff on surveillance, accommodation for those in quarantine, provision of medical supplies (gloves masks and sanitizers ) purchasing ambulances and personal protective equipment among others but not on beefing up water, sanitation and hygiene provision.

South Sudan refugees fetching water from a newly constructed water system. Photo by Julius Kasujja (1).jpg

Prioritizing investment in water provision

Already, in their 2018 sector report, the Ministry of Water and Environment indicated that financing remains one of their major challenges. The ministry in their sector strategic investment plan clearly indicates that the sector requires at least 9 times the present annual level of funding over the next 12 years if they are to achieve the water and environment related national targets under the Vision 2040 and the Sustainable Development Goals (SDGs).

The question that lingers is how much investment from the supplementary budget and other sources has been put to boosting the provision of water to combat the spread of COVD-19?

As the Government continues with the efforts of curbing the spread of COVID-19, it is critical that special focus is put to ensuring that households and generally all Ugandans can access and afford water to facilitate regular handwashing as recommended. This calls for the allocation of a budget to the Ministry of Water and Environment to continue rolling out water coverage initiatives as well as deliberate support from the Ministry of Health in collaboration with local governments to support the provisions of hand washing water and soap to poor and low-income households.

As a preparedness measure, stakeholders, especially the Government need to ensure that there is access and availability of water for all. Guaranteeing water for handwashing is key in the prevention measures and it will complete the equation in the fight against the spread of coronavirus. This will ensure that progress made so far in controlling the spread of the virus is not reversed. Guaranteeing the right to water as a human right is integral to the realization of the right to health and dignity.