Community-led project to reduce schistosomiasis risk and improve WASH in Uganda

Between July 2020 and January 2026, Unlimit Health collaborated with partners on a community-led project to identify schistosomiasis risk reduction initiatives. 

The collaboration began with a pilot project in three communities with a high prevalence of schistosomiasis infection in Kamuli district, eastern Uganda. The pilot tested approaches and methods to enhance community innovation and participation in health protection measures. Additionally, it provided insights for further collaboration between Unlimit Health and partners for disease prevention.  

Following on from the pilot project

Based on the pilot and having secured additional funding, in September 2023 the project partners began delivery of key water supply, sanitation and health promotion interventions identified in the community action plans of the three communities that participated in the pilot. 

Key achievements include: 

• A baseline survey which established levels of access to water supply and sanitation infrastructure, levels of contact with contaminated surface water, and willingness to pay for improved services. The survey also provided important insights on behaviours and practices related to schistosomiasis transmission, as a basis for future interventions.    
• A new water supply system: The key driver of communities’ exposure to schistosomiasis is contact with contaminated surface water. The project supported implementation of an innovative alternative water supply system, the Gravity-diverted membrane filtration (GDM) system, to help reduce reliance on contaminated surface water.  

Future plans

Unlimit Health continues to collaborate with the Uganda Ministry of Health to secure further resources to build on existing achievements. In addition to securing uptake of the GDM system in additional high-risk communities, further activities include:

• Community environmental adaptations testing: Not all water contact is mediated by access to safe water supply. Fishing, rice farming, sand mining and recreational swimming all take place in the project communities and are tied to daily lives and livelihoods. Other measures are needed to reduce the risk of schistosomiasis transmission and exposure and could include activities such as making contact sites less likely to harbour disease-transmitting snails. Such activities require further community discussion and action.  
• Sanitation: The eggs of the schistosomiasis species most common in Uganda (S. mansoni) are excreted into the environment through human faeces. Sanitation improvements are part of a risk-reduction strategy. Future work will support existing government-led initiatives to improve sanitation infrastructure and practices.
• Behaviour change communication: A campaign based on social mobilisation through radio and engagement of traditional leaders, and on enhancing existing health promotion activities, will be developed to address misconceptions and increased awareness on the transmission of schistosomiasis.  

Key lessons

Several important lessons emerged from the project: 

• Community ownership drove sustainability: One of the strongest successes was the high level of community engagement and commitment. This reflected the fact that the project design and activities were firmly based on communities’ own analyses of schistosomiasis and associated WASH and environmental factors. The project demonstrated that communities were willing to contribute towards services they valued, increasing confidence that the solutions could be sustained over the long term without undermining the accountability of government service providers.
• Building local capacity was essential: The water treatment technology used by the project (gravity-driven membrane filtration (GDM)) was relatively new in Uganda, so investing in the skills of local engineers and government officials was a priority. By involving these stakeholders in training, supervision, and implementation, the project helped community members recognise that the system was government-owned, supporting its local maintenance and integration into government-led services.
• Collaboration across sectors was key: While coordinating different ministries presented challenges, the project demonstrated that strong leadership, clear communication, and shared goals could help partners work together effectively.
• Appropriate technology could deliver lasting value: When assessed across all components, the GDM system was considered a cost-effective water supply intervention due to its significant efficiency advantages, ease of maintenance, higher reliability compared with boreholes, and users’ preference for river water.