Piloting a community-led approach in Uganda

Project context

Low access to quality reliable water supply and sanitation services sustains the transmission of schistosomiasis (SCH), including in areas where mass drug administration (MDA) has been implemented regularly. In Uganda, SCH is found in 91 of 147 districts, and high levels of transmission persist in some areas despite over 20 years of mass treatment.

Addressing the unmet need

As part of our technical collaboration with ministries of health (MoH), Unlimit Health is keen to play a role in enhancing the effectiveness of water, sanitation and hygiene (WASH) interventions for disease prevention, and the targeting of such interventions to high-prevalence areas. Communities in which SCH prevalence is high often experience low levels of access to quality water and sanitation services.

About the project

This one-year pilot project aimed to develop and test an approach to community-driven planning of environmental and behavioural action to reduce the risk of SCH transmission. The project was intended to also provide insights for further collaboration between Unlimit Health and government partners for disease prevention, and was the first project of its kind for Unlimit Health.

The project was delivered in three communities with a high prevalence of SCH infection in Kamuli district, Eastern Uganda, and was comprised of three phases:

• Participatory appraisal to identify the root causes of the risk of SCH transmission in the community
• Community action planning to identify basic measures to protect community members from infection
• Joint planning with local water and sanitation authorities to increase accountability of service providers and improve access to water and sanitation services and infrastructure.

Key lessons

The participatory approach applied in this project led to a joint understanding of infection risk and community needs between community members and public service providers. This is likely to improve the buy-in for and maintenance of future interventions.

• Discussions with the community and with service providers led to potential innovations, including measures for environmental modification to reduce the population of SCH-transmitting snails, and application of locally-appropriate water supply and sanitation technologies.
• The project helped renew the momentum for collaboration across the WASH and health sectors for tackling SCH and other NTDs.

What’s next

Based on the pilot and having secured additional funding, the project partners are working on the delivery of key water supply, sanitation and health promotion interventions identified in community action plans of the three communities who participated in the pilot.  The project will explore implementation of the participatory planning approach in additional high-risk communities.