COVID-19’s Transformation of the Slums:

The effects of COVID-19 on the sanitation and hygiene of the slums in Kampala

Slums are known to have a high density of population packed into unplanned houses and makeshift shelters, poor sanitation, and poor hygiene. Water sources are contaminated, waste has clogged water channels, waste management is subpar, and there aren’t enough sanitization facilities. The pandemic has hit mostly urban areas around the world because of the density of the population as business transactions happen. At the end of a business day, people leave the city, and the outskirts and slum areas get filled with residents.

To improve the sanitation and hygiene of the slums in Kampala, numerous interventions and campaigns have been launched. The water channels have been unclogged through community clean-up exercises by Slum Life Survival and the efforts of the KCCA (Kampala City Council Authority) and other organisations, however, the current pandemic has stifled the progress achieved so far. By April 3, 2020, the Ugandan government had already released UgShs157 billion to the national COVID-19 task force. The budget proposal also included KCCA, which took UgShs3.4 billion for water and sanitation. (April 3, 2020, The Daily Monitor Report)

How Covid-19 has affected Sanitation and hygiene?

Prior to the pandemic, the government was able to put sanitation control measures in place, and VHTs (Village Health Teams) were educating locals about the risks of unhygienic conditions. The urban council’s collection of garbage from disposal sites brought the health system to a stable state.

Today the situation is very alarming because of the lockdown. Sanitation has been ignored, and in some areas that have no community toilets or where toilet usage is for a fee, residents are paying 200 shillings per person, which is very difficult for a family of six to pay for such an amount every time children access the toilet.

During this pandemic lockdown, most of all WASH systems, including the waste collectors, are no longer on schedule, and when some find time to collect the waste in the informal settlements, the majority of people don’t have money to pay for their waste disposal. This has led to a good number of people disposing of waste everywhere, and some people wait under the cover of darkness to dispose of their waste indiscriminately.

In some communities, there had been a centralized system of collecting waste, which was also a source of income for the garbage collectors within the communities. Without garbage collectors, the disposal points have become full, as have the water channels, which are being treated as dumping grounds for garbage and waste. If the pandemic continues for a long time with no mitigating actions for the slums, we are likely to be faced with another battle of disease outbreaks like cholera due to poor sanitation, which is currently leading in the informal settlements that make up most of Kampala city. The current change in the rainy season due to climate change has had adverse effects on the communities. The clogged water channels flood during the rainy season, and those communities living in the wetlands, continuously get their homes flooded.

Sanitation facilities

The pandemic has highlighted the dire state of sanitation in the communities and the insufficient facilities available. Many people living in these communities earn about $1.40 or less a day, and somehow they have managed to feed their families, provide little medical attention when needed, and maintain a hygienic home. These communities cannot pay for waste collection and toilet access because of insufficient income.

Some families have more than six children, and the cost of using a toilet per person is 200 Ugandan shillings every time you use it. For a family of six, it would be a big challenge to deal with. This has led to open defecation and poor human waste disposal, which have brought back sanitation and hygiene challenges.

We reached out to some residents and WASH volunteers to discuss with them how they are managing their sanitation and hygiene during COVID-19.

We spoke with Christopher Tumwine a community WASH volunteer promoter with KCCA in Kamwokya Parish, Central Division, and Kampala City. He told us how the situation in his community is becoming unbearable for the urban poor. How they sanitize their hands before entering their house, and the message of frequent handwashing with soap being very effective in stopping the spread of coronavirus are well received in Kamwokya Settlement; however, the implementation is quite challenging for the slum dwellers who cannot afford to buy soap or water, and it also defeats the purpose because, when some households are dispensing the soap onto the hands, they end up contaminating the surfaces of objects like bottles.

Annet, a resident of Namuwongo, says, “Our settlement has many people; houses are close to each other, and so this social distancing we hear of is a myth in the slums; it is something designed for people living in well-to-do parts of the city. We are just lucky that the coronavirus has not reached the slums, and we pray to God that it does not reach us here in the slums. We have shared toilets, bathrooms, and public water taps; our children always get out of the houses to play with other kids in the neighborhood.”.

Hygiene

The use and management of sanitary facilities has also led to an increase in disputes between landlords and their tenants. Before the lockdown, children would spend most of their time at school or away from home; today everyone is at home, putting much pressure on the few available sanitation facilities. One slum resident opened up to us about how the landlord called for a meeting with tenants, raising issues of children damaging latrine facilities. They added, “We have many quarrels in the community over the use of sanitation facilities since many are shared among different families and some people leave them dirty after using them”.

Previous campaigns before the pandemic focused on sensitizing communities about hand-washing practices. Despite these campaigns, people were not vigilant about hand washing. The COVID-19 handwashing campaigns have helped to create more emphasis on handwashing as a basic hygiene practice that can help you fight off COVID-19 and ultimately also fight off other hygiene-related diseases.

There is a general need for handwashing points in homes and public places like markets, restaurants, and even shops. Access to clean water and soap in places like slum homes can be a challenge in this fight. If water sources are not equally protected to make them safe and clean, then it becomes ineffective to prevent one from getting COVID-19 and other water-borne diseases even with the use of soap.

Recommendations

After closely examining the challenges met during this COVID-19 pandemic in the slum communities, the following measures are recommended:

• Kampala City Council Authority (KCCA) needs to work closely with the government agency on water and sewerage (NWSC) to make clean water accessible to the slum communities by extending the current water system to reach deep in the slums.
• Making the water bills affordable for the communities is important. Alternatively, as part of the COVID-19 mitigation strategies, the government needs to subsidise almost 70% of the NWSC’s current expenditures.
• If at all, a person in the slums is suspected or confirmed to have COVID-19, they should be withdrawn from the community. An attempt to quarantine a patient within the slums makes it highly risky for the community.
• As part of the measures, the slum communities need to be provided with soap, specifically bar soap, and also detergents like ‘Omo’ and antiseptics to help in washing hands as well as cleaning the toilets. Toilets need to be cleaned at least twice a day. Further, and consistent with existing guidance, restaurants and public places with toilets need to have them cleaned up three times a day with disinfectants by workers wearing masks, gloves, and boots. The boots are later disinfected as well and not worn after to avoid spreading any contamination on the ground.
• Strategies to stop the spread of coronavirus in Uganda need the involvement of community structures like the KCCA WASH initiative, ‘WEYONJE’ and Village Health Teams (VHTs). When trained and facilitated, one can carry out house-to-house community sensitization of the community residents on proper and regular sanitation hygiene, both handwashing with water and soap, as a defense against the spread of coronavirus.

In conclusion

When you move around in Kampala slums, it is very clear that people are very much aware of COVID-19, and due to government measures put into existence, social distancing and hand-washing measures are more effective because, in most informal settlements like Kinawataka, Mulago Katanga, Kamwokya houses are overcrowded, physical space is scarce, and many residents rely on daily wage labour for survival. Limiting them from work has brought more challenges, like the rise in domestic violence.

At this point, the country has not registered any community cases. In case the coronavirus pandemic reaches the urban poor settlements of Kampala, it can become a death bed simply because of the congestion, lack of proper sanitation and hygiene services. The communities need to take more action on the spread of COVID-19.

To deal with the COVID-19 pandemic, we need to have volunteers and VHTs take temperature measurements in different slum locations, and we need to understand that one size does not fit all. Measures that work in affluent communities of the city may not necessarily work the same way in the slums. For the urban poor to weather the COVID-19 pandemic, governments should prioritize the provision of essential needs, including improving access to safe water, sanitation, and hygiene sensitisation.