Better health is in our hands

In this article published on 15 May 2024 in Uganda's Daily Monitor, Dr Diana Atwine, Permanent Secretary, Ministry of Health, Uganda and SHF’s Dominic O’Neill warn against washing away years of public health progress due to a lack of attention and financing to sanitation and hygiene, the fundamental line of protection for individual, community and planetary health.

‘Wash your hands with soap to protect yourself’. It would be impossible to count the number of times we heard these words during the COVID-19 pandemic. Almost as impossible as it is to believe that this simple yet effective form of protection against serious, even fatal, diseases is elusive to at least a quarter of the world’s population. Indeed, even today, 1 in four people worldwide lacks basic handwashing facilities at home. This is a health emergency for them, their communities and our planet.

It was little less than 200 years ago that British physician John Snow correctly identified a water pump as the source of a devastating cholera epidemic that was ravaging London at the time. The removal of the pump set in motion frameworks to build water and sanitation systems around the world as a first line of protection against the deadly disease. The centuries since have seen important progress also made on vaccines. But after decades in decline, cholera is back with over 20 countries already reporting active outbreaks in 2024 and zero doses of vaccines left in the stockpiles. Zero, another impossible to fathom number.

We have before us an opportunity, and a responsibility, to turn these numbers around. With the climate crisis accelerating globally, public health crises linked to poor or absent sanitation and hygiene infrastructure risk becoming more frequent and deadlier, especially for women and children. We cannot wait to act.

Today, 60 percent of Uganda’s disease burden is linked to sanitation and hygiene which means investing in the sanitation economy can have cascading positive effects on individual and public health. With the possibility to generate vital access, livelihoods and businesses along a robust value chain built around toilets, from installation to collection, transport, treatment and reuse, national sanitation economies offer interesting prospects for impact investment. In Uganda, the sanitation economy is estimated to have the potential to grow from US$ 1.7 billion today to US$ 2.7 billion in 2030 once universal access is achieved. And there is also the aspect of planetary health.

Estimates suggest that almost a half of Kampala’s greenhouse gas emissions (methane) are related to sanitation. Investing in climate-resilient sanitation and hygiene can not only support the country’s health outcomes but its climate ambitions too, both in terms of mitigation and adaptation. Globally, adopting a circular sanitation approach has the potential to unlock 3.8 trillion litres of human waste every year from toilets and sanitation systems for reuse in the wider economy for agricultural and energy purposes.

Investment in sanitation and hygiene is an investment in individual, public and planetary health. A WHO study in 2012 calculated that for every US$ 1.00 invested in sanitation, there was a return of US$ 5.50 in lower health costs, more productivity and fewer premature deaths.

These are the numbers we need to be chasing and this is why the government of Uganda is partnering with the UN's Sanitation and Hygiene Fund (SHF), with support from the governments of the Netherlands and Switzerland, on a US$ 5 million project to address open defecation and poor sanitation in seven districts in the country through market-based approaches. 

With conflict, instability, climate shocks and global economic disparities all but growing, the actions we need to take are much more and deeper than the removal, or even installation, of a single water pump or toilet. Better health lies in our hands, literally. And so do our ambitions for an inclusive, climate-resilient future. We cannot flush this opportunity away.