1
For discussion, not for circulation 
USAID/Uganda Sanitation for Health (S4H)
Task 1.1.1 Develop a National Sanitation Market Strategy
In-depth research findings: 
Institutional customers
2
For discussion, not for circulation 
Acronyms and terms
CAO Chief Administrative Officer JMP UNICEF/WHO Joint Monitoring Programme 
DE District Engineer MBS Market-based sanitation
DEO District Education Officer MoES Ministry of Education and Sports
DHO District Health Officer MoH Ministry of Health
DHI District Health Inspector MWE Ministry of Water and Environment
FSM Fecal sludge management NSMS National Sanitation Market Strategy
HC Health Center O&M Operations and maintenance
HF Health Facility S4H Sanitation for Health
HH Household Permanent 
materials1
Construction materials that can maintain their stability 
for more than 15 years; e.g., concrete, cement screed, 
tiles, iron sheets
IBT Improved (at least basic) toilet Temporary 
materials1
Construction materials that can maintain their stability 
for no more than 3 years; e.g., grass, mud, wattle
1. National Population and Housing Census 2014: Analytical Report, Uganda Bureau of Statistics, government of Uganda, 2017
3
For discussion, not for circulation 
Executive Summary
 All public and private institutions are required to construct separate improved toilets for different user types 
(male/ female, user/ staff), based on prescribed designs, and adhere to standard user-stance ratios
 While all public and private institutions have improved toilets, they do not provide separate toilets as per the 
guidelines; public institutions also have a low overall user-stance ratio
 The key barriers faced by institutions are:
– Low budgets for toilet construction; the inadequacy of funds for public institutions is further exacerbated 
by a potentially high-cost prescribed design for a toilet block
– Low flexibility in how separate toilets may be provided for different user types, necessitating the 
construction of new toilets within already limited budgets 
– Low availability of pit emptiers, and low budgets for O&M (including pit emptying) in the case of public 
institutions, also necessitating the construction of new toilets
4
For discussion, not for circulation 
Contents
 Overview
 Context
 Barriers faced by public institutions
 Barriers faced by private institutions
 Appendix
5
For discussion, not for circulation 
Overview | Background
 The USAID Uganda Sanitation for Health Activity (S4H) is supporting the Ministry of Health to develop a National 
Sanitation Market Strategy (NSMS) aimed at increasing access to and use of improved sanitation through market 
interventions
 As part of this process, over the last year, S4H has carried out both secondary and primary research to better 
understand the current situation of the sanitation market in Uganda, focused on identifying drivers for, and barriers 
to, the provision of improved sanitation
 This involved speaking with experts from the government, NGOs, and the private sector, and conducting in-depth 
interviews with households, institutions (schools and health facilities), and actors in the sanitation value chain (e.g., masons, 
pit diggers, hardware stores, financiers)
This document presents the key findings of the institutional customer research. Our research covered both public and 
private institutions with the aim of understanding their:
 Setting, including institutional characteristics (e.g., number of students/ patients, number of staff, type of material used to 
construct the building) and geographic characteristics (e.g., whether it is situated in urban or rural areas, whether it has 
access to water sources)
 Sanitation preferences, including current sanitation practices, current products used, desired product features, and their 
ability and willingness to pay for sanitation products
 Sanitation buying behavior, including the roles and responsibilities of those involved in the purchase decision, their 
choice of information sources, materials, and service providers, and the reasons for these choices
6
For discussion, not for circulation 
Overview | High-level approach
Understand sanitation 
landscape
 Secondary research to 
understand sanitation 
indicators, practices, 
products, and challenges
 Immersion field trip to 
understand context of 
institutional customers
 Hypotheses on barriers 
and drivers towards 
purchase of improved 
sanitation based on 16 
institutional customer 
interviews 
 Key areas of inquiry for 
in-depth study
Prepare for in-depth 
institutional research
 Define research areas in 
consultation with 
UBOS
 Develop and test 
quantitative 
questionnaires
 Select and train data 
collection agency
 List of 10 districts that 
cover a range of 
sanitation contexts
 Digitized questionnaires 
for schools and health 
facilities
Conduct in-depth 
institutional research
 Analyze quantitative 
and qualitative data to 
identify key barriers and 
drivers 
 Final list of key barriers 
and drivers affecting the 
ability of institutions to 
purchase improved 
sanitation products
Key activities Outputs
Develop
insights
 Generate a list of 
institutions through 
household interviews
 Interview a select 
sample of the listed 
institutions
 Conduct qualitative 
interviews with district 
officials
 104 in-depth 
institutional interviews
 12 qualitative 
interviews with district 
officials
Apr 2018 – Jul 2018 Jul 2018 – Oct 2018 Oct 2018 – Nov 2018 Nov 2018 – Jan 2019
7
For discussion, not for circulation 
Overview | Research areas
1. Measures relative ability of households in a district to pay for construction of sanitation facilities using a composite of UBOS’s poverty indicator, household asset 
ownership, percentage of households in the district that consume less than two meals a day, and materials used for house construction
2. Measures relative difficulty faced in accessing materials for construction of sanitation facilities in a district using a composite of average distance from the nearest road, 
whether the district is difficulty to reach, and whether the district is affected by armed conflict
3. Measures relative availability of private product and service providers in a district using a composite of average distance of households from the nearest market selling 
general merchandise, percentage of households which have at least one member engaged in non-agricultural household based enterprise, and percentage of households 
with water connections in own yard/ plot/ building
We undertook institutional customer research in 10 districts, offering a spread across different sanitation contexts. This 
research was conducted along with household (HH) customer and value chain research
List of districts for in-depth research Legend for district type
1 2 3
Non-S4H districts
S4H program districts
8
For discussion, not for circulation 
Overview | Sample size
1. We selected institutions for quantitative interviews in consultation with district officials and local leaders. The institutions were selected from a pool of institutions 
generated by inquiring from HH customers, during the HH listing interviews, as to which health facilities and schools they use 
Qualitative research
We conducted 104 quantitative interviews in 10 districts, and 12 qualitative interviews with district officials in 5 districts 
as part of the in-depth research; also conducted 16 qualitative interviews with institutions as part of the Immersion visit
Quantitative research1
District Public 
institutions
private
institutions Total
Jinja 7 4 11
Bukomansimbi 7 4 11
Kabarole 6 4 10
Mityana 6 4 10
Ngora 6 4 10
Buyende 6 4 10
Kibaale 6 4 10
Gulu 7 4 11
Arua 6 4 10
Kotido 7 4 11
Total 64 40 104
District # of district officials
interviewed
Bukomansimbi 2
Buyende 2
Gulu 3
Kabarole 2
Ngora 3
Total 12
Qualitative research (Immersion visit)
District # of institutions
interviewed
Arua 4
Kampala 1
Kibaale 6
Mukono 5
Total 16
9
For discussion, not for circulation 
Overview | Sample composition 
We conducted quantitative interviews across a range of public and private institutions including primary and secondary 
schools, and health facilities across different levels1
Schools interviewed by type
23
9
10
10
33
Primary 
19
Private schools
schools
Secondary 
schools
Health facilities interviewed by type
7
12
16
4
5
7
Clinic HC II HC III HC IV
7
1
Hospital
17
23
4
1
Public schools Private facilities Public facilities
1. Uganda’s health facilities are classified into seven levels based on the services they provide and the catchment area they are intended to serve. The health facilities are 
designated as Health Center level one (HC I) to Health Center Level four (HC IV); General hospital, Regional Referral hospital and National Referral hospital 
We analyzed the context and identified barriers for institutions as a whole while calling out nuances across institution type (school or health facility) 
and ownership (public or private)
10
For discussion, not for circulation 
Contents
 Overview
 Context
 Barriers faced by public institutions
 Barriers faced by private institutions
 Appendix
11
For discussion, not for circulation 
Context | Prominence of public institutions (1/2)
77.0%
23.0%
Total school 
enrolment
10.1 M
Public schools cover 77% of total school enrolments in Uganda, and are also better distributed across regions when 
compared with private schools1
77% of all students attending school are in 
public schools
Non-public
Public
Public schools are well distributed across regions; private 
schools have a relatively higher concentration in the Central 
and Western regions
21.5%
33.0%
36.2%
Public
Schools
19.7%
29.9%
25.7%
24.7%
9.3%
Non-public 
schools
13,167
9,621
1. Education Abstract 2016, Ministry of Education and Sports, government of Uganda
Northern region
Eastern region Central region (including Kampala)
Western region
12
For discussion, not for circulation 
Context | Prominence of public institutions (2/2)
1. Based on data collect
Daily number of outpatients per facility
ed from interviews with 32 public health facilities, 20 private health facilities, during the in-depth research
2. National Health Facility Master List, Division of Health Information, Ministry of Health, government of Uganda, June 2017
81
37
Public health 
facilities
Private health 
facilities
Public facilities cater to more than double the 
number of outpatients per day, compared to 
private facilities1
Public facilities are well distributed across 
regions; nearly all private facilities are in the 
Central region2
Similarly, public health facilities cater to a higher number of outpatients, and are better distributed across regions when 
compared with private facilities
21.8%
23.4%
25.8%
29.0%
3,084
Public health 
facilities
16.8%
8.7%
94.5%
19.9%
Private health 
facilities
3,320
Eastern region
Northern region Western region
Central region (including Kampala)
13
For discussion, not for circulation 
Context | Legal requirements for toilet construction (1/2)
1. National Environment Health Policy, government of Uganda, 2005
2. The Public Health Act, government of Uganda, 2000
3. Ministry of Education, Science, Technology And Sports Issues Paper For Local government Consultative Workshops FY 2016/17 
The government of Uganda has put in place a number of measures to ensure adequate sanitation provision in all public 
and private institutions
 The National Environment Health Policy (2005) requires all public and private buildings to have toilets; this 
includes schools and health facilities1
 The Public Health Act (2000) empowers local authorities to:2
– Issue improvement notices to owners of buildings that do not have adequate sanitation facilities, and penalize 
those owners who do not take remedial action
– Deny approval for construction of any building that doesn’t provide for sufficient and satisfactory sanitation 
facilities in its building plan
 The Ministry of Education and Sports mandated that:
– At least 50% of the annual School Facilities Grant (SFG) go towards construction of toilets in primary schools
– If local governments want to use SFG funds for other purposes, they need to demonstrate that their district has 
achieved the target pupil-stance ratio of 40:13
14
For discussion, not for circulation 
Context | Legal requirements for toilet construction (2/2)
All public and private institutions are required to construct separate improved toilets for different user types (male/ 
female, user/ staff), based on prescribed designs, and adhere to standard user-stance ratios
 Pupil stance ratio of 40:1
 Separate toilets for teachers and students
 Separate toilets for males and females
 At least one stance for children with special needs
 All toilets should have, washable floors; doors; and hand-wash facilities
 All toilets should have lined pits to enable emptying2
1. National School Sanitation Guidelines, Ministry of Education and Sports, government of Uganda, 2017
2. Uganda Sanitation Diagnostic Study Report, Gibson J., Eales K, and Nsubuga-Mugga C., World Bank, May 2017
3. Based on qualitative interviews with district officials from 5 districts – Bukomansimbi, Buyende, Gulu, Kabarole, and Ngora
4. Water Supply Design Manual, Ministry of Water and Environment, Directorate of Water Development, 2000
 User stance ratio of 25:14
 Separate toilets for staff and patients
 Separate toilets for males and females
 Provision for patients with disabilities
 Toilets should have 3-6 stances depending on size of the health facility
 Toilets serving the maternity ward should have a bathroom
 All toilets should have hand-wash facilities
Guidelines for toilets in health facilities3
Guidelines for toilets in schools1
15
For discussion, not for circulation 
Context | Access to sanitation in public and private institutions
1. Based on data collected from interviews with 32 public schools, 20 private schools, 32 public health facilities, and 20 private health facilities during the in-depth research
While almost all institutions have functioning improved toilets, and all health facilities have adequate user-stance ratios 
(USR), many public schools do not adhere to the guidelines regarding pupil-stance ratio (PSR)
3% 3%
20
97% 97%
Private
schools
100%
0%
Public
schools
Public
health 
facilities
0%
100%
Private
health 
facilities
32 32
20
Percentage of public and private institutions 
with functioning improved toilets1
USR in public and private health 
facilities 1
PSR in public and private 
schools1
Non-functioning toilets
Functioning improved toilets
62
39
Public
Schools
Private
Schools
40
(prescribed 
PSR)
26
(prescribed USR)
21
12
Public
facilities
Private
facilities
16
For discussion, not for circulation 
Contents
 Overview
 Context
 Barriers faced by public institutions
 Barriers faced by private institutions
 Appendix
17
For discussion, not for circulation 
Barriers | Public | Cost and budget challenges (1/4)
Low overall government budgets for toilet construction, coupled with a potentially high-cost prescribed 
design for a toilet block make it difficult for public institutions to increase their number of toilets
There is inadequate government funding for construction of toilets in public institutions
The prescribed design for public institution toilets is high cost – public institutions may be paying more than households 
might, if households were to buy a similar product system (5-stance VIP with bathroom)
a
b
1
As a result, public institutions find it difficult to increase their number of toilets, unless they can secure funds from other 
sources
c
18
For discussion, not for circulation 
There is inadequate government funding for construction of toilets in public institutions
a
Barriers | Public | Cost and budget challenges (2/4)
1. Based on interviews with district officials from 5 districts – Bukomansimbi, Buyende, Gulu, Kabarole, and Ngora 
1
“There is a lack of funding for sanitation. The education 
budget for FY 18-19 is UGX 552 M, out of which only UGX 146 
M is available to spend on all construction, including classrooms, 
teachers houses, latrines, etc. The rest is earmarked for the seed 
schools program.
MoES also allocates UGX 8,050 per child per year to 
schools, but this is for other expenses such as books, chalk, 
first-aid, sanitary pads, cleaning materials, sports materials etc." 
- Interview with district official
7
2
3
1
6
Availability of 
funding in 
public shcools
Availability of 
funding in public 
health facilities
7
Nearly all district officials interviewed stated that 
there was inadequate funding for toilets in public 
schools and health facilities1
“This year, the health department got only UGX 32 million as 
the total budget for infrastructure.”
- Interview with district official
No funding
Inadequate funding
No response
Note: Based on interviews with contractors, the average price of a 5-stance VIP, 
with a bathroom, is UGX 18 M – 22.5 M
19
For discussion, not for circulation 
The prescribed design for public institution toilets is high cost – public institutions may be paying more than 
households might, if households were to buy a similar product system (5-stance VIP with bathroom)
b
Barriers | Public | Cost and budget challenges (3/4)
1
1.8 M
1.0 M
4.1 M 0.3 M
1.4 M
1.6 M 10.2 M
Avg. cost of 2-
stance unlined 
IBT, with 
bathroom
Add: Pit lining 
& VIP pipes 
for 2 stances
Add: Total 
costs for 3 
more stances
Add: 
Contractor’s 
overhead 
costs @ 5%
Add: 
Contractor’s 
mark-up @ 
20%
Add: VAT 
@ 18%
Estimated 
built-up cost 
for 5-stance 
VIP, with 
bathroom
Avg. cost of 5 
stance lined 
school toilet
20.0 M
49%
 Even after scaling up costs of an average 2 stance IBT, 
the estimated cost of a 5 stance toilet is ~50% 
lower than the average price of a comparable 
school toilet
 While part of this difference may be explained by the 
differing quantities and qualities of material and labor 
used, there may be further scope for cost 
optimization
Avg. cost of 2-stance unlined IBT, with 
bathroom as currently incurred by HHs1
Estimated costs2
Avg. cost of 5-stance VIP, with bathroom, as 
incurred by public institutions 3
1. Average cost paid by households in rural Uganda for a 2 stance IBT with a 15 foot deep unlined pit, plastered walls, bathroom, and curtain wall; prices stated by 
households during the in-depth research varied from UGX 1.49 M to UGX 2.02 M
2. These costs have been developed by extrapolating quantities of materials and volumes of labor from the typical HH toilet to the estimated quantities and volumes 
required for a 5-stance VIP with a bathroom. We have multiplied these volumes and quantities with the typical price points noted during the in-depth research. We have 
added typical overheads, mark-up and VAT costs, as stated by contractors, during the in-depth research
3. Average cost paid by public schools for a 5 stance VIP toilet with a 10 foot deep lined pit, plastered and painted walls, bathroom, and curtain wall; price is inclusive of 
VAT and contractor’s mark-up; prices stated by contractors during the in-depth research varied from UGX 18 M to UGX 22.5 M
20
For discussion, not for circulation 
Barriers | Public | Cost and budget challenges (4/4)
1
- Interview with district official
“For health centers there is no public funding, 
so we depend on NGO partners to donate them. If 
a donor offers to build an OPD building, we include a 
toilet as part of the design.”
“There are 91 public primary schools in the district. All 
of them need additional toilets, but there is a budget for 
only 3 of them, in the next financial year. Parents are 
encouraged to contribute towards building pit 
latrines in the schools. These toilets do not have to be as per 
the MoES specifications (parents can’t afford that), and they 
don’t require any approvals." 
- Interview with district official
As a result, public institutions find it difficult to increase their number of toilets, unless they can secure funds 
from other sources
c
“The education department receives funds only once in a 
financial year, but schools make requests for new toilets year 
round. If we have exhausted our budget at the start of 
the year, we approach development partners for help 
(e.g., Save the Children) and ask if they can build the toilet." 
- Interview with district official
21
For discussion, not for circulation 
Barriers | Public | Low flexibility in provision of separate toilets (1/4)
Low flexibility in how separate toilets may be provided for different user types necessitates the 
construction of new toilets in public institutions
Most public institutions, in consultation with the local government, provide separate toilets for different user types by 
allocating separate stances within a toilet block to various user types 
However, the prescribed standards require institutions to provide separate toilet blocks for different user types
a
b
2
Most institutions do not meet these prescribed standards, necessitating new toilet construction
c
22
For discussion, not for circulation 
Barriers | Public | Low flexibility in provision of separate toilets (2/4)
1. Based on data collected from 30 co-ed public schools and 31 public health facilities with functioning toilets interviewed during the in-depth research 
2
31
0%
100%
Public
schools
81%
19%
Public health 
facilties
30
Most public institutions, in consultation with the local government, provide separate toilets for different user 
types by allocating separate stances within a toilet block to various user types 
a
Percentage of public institutions that have separate 
stances for male and female users1 “There is one type of toilet design for a boys’ block 
and one for a girls’ bock…we usually prefer to go 
with the design for the boys’ block as it has a urinal 
for the boys and the stances can be divided 
amongst boys and girls and both can use it. 
The children have to share a toilet block as we 
don’t have enough money to build separate 
ones"
- Interview with district official
Do not have separate stances for males and females
Have separate stances for males and females
23
For discussion, not for circulation 
Barriers | Public | Low flexibility in provision of separate toilets (3/4)
1. National School Sanitation Guidelines, Ministry of Education and Sports, government of Uganda, 2017
2
Secondary research
However, the prescribed standards require institutions to provide separate toilet blocks for different user 
types
b
For example, schools are required 
to provide:1
 Separate 5-stance VIP toilet 
blocks for boys with a 
urinal
 Separate 5-stance VIP toilet 
blocks for girls with a 
bathroom
 Separate toilets blocks for 
teachers
 Toilets that are constructed 
in a way that entrances for 
females are screened from 
those for males
24
For discussion, not for circulation 
Barriers | Public | Low flexibility in provision of separate toilets (4/4)
1. Based on data collected from interviews with 32 public schools, 20 private schools, 32 public health facilities, and 20 private health facilities during the in-depth research
2. Equity Drinking water, sanitation and hygiene in schools: Global baseline report 2018, United Nations Children’s Fund (UNICEF) and World Health Organization, 2018
3. Water, Sanitation, and Hygiene Service Availability at Rural Health Care Facilities in Southwestern Uganda, Mulogo et al, Journal of Environmental and Public Health, 2018
2
Most institutions do not meet these prescribed standards, necessitating new toilet construction
c
Majority of health facilities do not 
have a separate stances for patients 
with disabilities3
(Data for Southwestern Uganda)
Around half the public health facilities and 
a significant minority of public schools do 
not have separate toilet blocks for staff1
23%
Public
schools
77%
48%
52%
Public health 
facilites
Percentage of public institutions 
with separate toilet blocks for staff
facilities3 do not have separate toilet 
blocks for boys and girls
Most schools2 and many health 
(Health facility data for Southwestern Uganda)
Percentage of public and private institutions 
with separate toilet blocks for males and 
females
Public and 
private
primary 
schools
Public and 
private 
secondary 
schools
72%
28% 14%
86%
50%
50%
Public and 
private
health
facilities
Percentage of public and private health 
facilities with separate stances for 
disabled patients
18%
82%
Public and 
private health 
facilities
Separate staff toilet blocks
No separate staff toilet blocks
Separate stances for disabled
No separate stances
Separate male and female toilet blocks
No separate male and female toilet blocks
25
For discussion, not for circulation 
Barriers | Public | Inadequate access to pit emptying (1/3)
Low budgets for O&M (including pit emptying), and low availability of pit emptiers, necessitates the 
construction of new toilets in public institutions
Inadequate budget allocations for operation and maintenance, coupled with low availability of pit emptiers, makes it 
difficult for public institutions to access pit emptying services
As a result, most public institutions opt to build new toilets instead of emptying their existing toilets; this creates 
additional pressure on already constrained government budgets 
a
b
3
26
For discussion, not for circulation 
Barriers | Public | Inadequate access to pit emptying (2/3)
District officials interviewed in all 5 districts in which we 
conducted qualitative interviews, stated that while there 
is an overall budget for operation and maintenance of 
public institutions, no dedicated funds are allocated 
for toilet maintenance1
Primary research
1. Based on interviews with district officials from 5 districts – Bukomansimbi, Buyende, Gulu, Kabarole, and Ngora 
2. Uganda Sanitation Diagnostic Study Report, Gibson J., Eales K, and Nsubuga-Mugga C., World Bank, May 2017
3
According to a World Bank report:2
 Only 33% of public schools provide a budget for 
O&M of toilets
 Only 7% have adequate funds for O&M
Schools try to partly cover costs by charging 
development fees, however parents are often 
reluctant to pay for sanitation services in schools 
as they think this is the government’s responsibility
Secondary research
“Our health center was allocated UGX 250,000 for 
the entire year as the budget for toilet 
maintenance. However, hiring a cesspool pit 
emptier alone costs UGX 280,000.”
- Representative from a public 
health center
- Interview with district official
“Schools are responsible for repairs, cleaning and 
maintenance of their own toilets, but it is a challenge as 
they don’t have the budget for it. If schools want their 
pit emptied, they can write to the department of education. 
However, the department only has budget to empty 
10 toilets, across the district, in a year. There are no 
pit emptiers in our district. They come from another district, 
and this increases the cost." 
Inadequate budget allocations for operation and maintenance, coupled with low availability of pit emptiers, 
makes it difficult for public institutions to access pit emptying services 
a
27
For discussion, not for circulation 
Barriers | Public | Inadequate access to pit emptying (3/3) 3
11%
67%
17%
0
Public health 
facilties
33%
Public
schools
72%
9
18
According to a World Bank diagnostic report, only 
17% of school toilets in Uganda have ever 
been emptied, despite the majority now having 
lined pits that are emptiable. 
This is attributed to a lack of safe emptying 
options, or the inability of schools to raise the 
required funds. Schools are responsible for raising 
funds for pit emptying, however many parents 
(especially the poorer ones,) find it difficult to 
pay for pit emptying or the construction of 
replacement facilities.2
Secondary research
As a result, most public institutions opt to build new toilets instead of emptying their existing toilets; this creates 
an additional demand on already constrained government budgets 
b
Percentage of public institutions that plan to construct 
a new toilet when the pit of their current toilet fills
Don’t know
Have pit emptied
Build a new toielt
1. During the in-depth research, we asked institutions with toilets over 3 years old what they intended to do once the pit of their toilet was full. The data reported here is 
based on answers from 9 public schools and 18 public health facilities that answered the question
2. Uganda Sanitation Diagnostic Study Report, Gibson J., Eales K, and Nsubuga-Mugga C., World Bank, May 2017
28
For discussion, not for circulation 
Contents
 Overview
 Context
 Barriers faced by public institutions
 Barriers faced by private institutions
 Appendix
29
For discussion, not for circulation 
Barriers | Private | Low flexibility in provision of separate toilets
Low flexibility in how separate toilets may be provided for different user types necessitates the 
construction of new toilets in private institutions
1. Based on data collected from 19 co-ed public schools and 20 public health facilities with functioning toilets interviewed during the in-depth research
2. Based on data collected from interviews with 32 public schools, 20 private schools, 32 public health facilities, and 20 private health facilities during the in-depth research
4
Private health 
facilties
80%
0%
100%
20%
19
Private
schools
20
Most private institutions provide separate toilets for 
different user types by allocating separate stances within a 
Percentage of private institutions that have separate 
stances for male and female users1
toilet block to various user types1
However, as with public institutions, most private 
institutions do not provide separate toilet blocks for 
different user types
Percentage of private institutions with separate 
toilet blocks for staff2
45%
60% 55%
40%
Private schools Private health 
facilites
Do not have separate stances for males and females
Have separate stances for males and females
Separate staff toilet blocks
No separate staff toilet blocks
Please refer to slide 23 for prescribed design, and slide 24 for 
additional information on separation of blocks
30
For discussion, not for circulation 
Barriers | Private | Inadequate access to pit emptying (1/3)
Low availability of pit emptiers necessitates the construction of new toilets in private institutions, despite 
the fact that they have adequate user-stance ratios
The low availability of pit emptiers makes it difficult for private institutions to access pit emptying services
As a result, most private institutions opt to build new toilets instead of emptying their existing toilets
a
b
5
31
For discussion, not for circulation 
Barriers | Private | Inadequate access to pit emptying (2/3) 5
Expert interviews with GIZ revealed that the 
availability of treatment plants outside Kampala is 
a challenge. The cost of emptying depends on the 
volume of sludge in the pit and the distance of the pit 
from a treatment plant; the further the pit, the higher the 
transport costs for the emptier. As pit emptiers pass the 
transport cost onto the customer, institutions outside 
Kampala pay a higher price for pit emptying.
Primary research
1. Consumer Insight and Sanitation Supply Study, Uganda, SNV, January 2015
2. Analysis of the Sanitation Supply Chain in Rural and Small Towns in Uganda, PATH, 2012
A study on the sanitation supply chain in rural and small 
towns in Uganda noted that that there was a “lack of 
widespread pit emptying service provision”. Most 
of the existing pit emptying trucks are based in 
Kampala. These emptiers are willing to offer services 
across a broad geographical area, but charge by the 
distance they have to travel; this greatly increases the 
cost of pit emptying.
2
Secondary research
A study by SNV noted that there are no pit emptying 
services or treatment facilities in rural Uganda; 
this poses a significant challenge to schools in rural areas. 
Though the government plans to set up additional 
treatment facilities in rural areas, this will take time.1
Secondary research
The low availability of pit emptiers makes it difficult for private institutions to access pit emptying services 
a
32
For discussion, not for circulation 
Barriers | Private | Inadequate access to pit emptying (3/3) 5
0
11
0
27%
43% 27%
Private
schools
57%
1
36%
Private 
health facilties
7
As a result, most private institutions opt to build new toilets instead of emptying their existing toilets
b
More than half of private schools and more than a third of private health facilities 
plan to build new toilets when their toilet pits fill up1
Percentage of private institutions that plan to construct a 
new toilet when the pit of their current toilet fills up
Other
Will build a new toielt
Will have pit emptied
Don’t know
1. During the in-depth research, we asked institutions with toilets over 3 years old what they intended to do once the pit of their toilet was full. The data reported here is 
based on answers from 7 private schools and 11private health facilities that answered the question
33
For discussion, not for circulation 
Barriers | Private | Inadequate funds for new toilet construction (1/3)
Private institutions have inadequate funds to invest in new toilets, as their earnings are limited due to the 
affordability constraints of their users
6
Private institutions depend on user fees to cover operational expenditure
However, most households are unable to afford the fees; this limits the ability of private institutions to invest in new 
infrastructure, including toilets
a
b
34
For discussion, not for circulation 
B
Private institutions depend on user fees to cover operational expenditure
a
arriers | Private | Inadequate funds for new toilet construction (2/3)
1. Low Fee Private Schools in low-income districts of Kampala, Uganda, Harma, J. and Pikhold, L., CapitalPlus Exchange Corporation, 2017
2. Uganda’s Private Health Sector: Opportunities for Growt, USAID, April 2015
6
96%
4%
100%
62%
16%
16%
6%
100%
According to a survey of private schools in 
Kampala, 96% are dependent on fees to meet 
their operational expenditure, including capex1
Source of funds used by private schools to meet 
operational expenses
According to a survey of private health facilities in 
Uganda, 62% rely on retained earnings to meet 
their operational expenditure, including capex2
Source of funds used by private health facilities to 
meet operational expenses
Other sources
Parent fee payments
Formal loans
Informal loans
Supplier credit (supported by user fees)
Retained earnings (from user fees)
35
For discussion, not for circulation 
Barriers | Private | Inadequate funds for new toilet construction (3/3)
1. Low Fee Private Schools in low-income districts of Kampala, Uganda, Harma, J. and Pikhold, L., CapitalPlus Exchange Corporation, 2017
2. Privatisation, Discrimination and the Right to Education in Uganda, ISER and the Global Initiative for Social and Economic Rights, June 2015
3. Uganda’s Private Health Sector: Opportunities for Growth, USAID, April 2015
6
However, most households are unable to afford the fees; this limits the ability of private institutions to invest in 
new infrastructure, including toilets
b
Percentage of parents who pay fees regularly
8%
29%
Regular and reliable
49%
14%
According to a survey of private schools in 
Kampala, 37% of parents do not pay fees regularly; 
and 42% are behind on the payment of their 
children’s fees1
According to a report on privatization of education in Uganda, 
“Private schools often charge fees that are above the 
resources of most Ugandans”. This is demonstrated by the 
fact that:
 ~81% of households with out-of-school children, cited lack 
of money as the reason for their children not being in school
 ~58% of households claimed financial constraints was 
the reason their children never enrolled in school2
Secondary research
According to a USAID study, “78% of private health facilities 
cited the lack of financing as the major constraint in running 
operations.”3 This limits their ability to purchase new 
equipment.
Secondary research
Often irregular
Always irregular
Mostly regular, sometimes late
36
For discussion, not for circulation 
Contents
 Overview
 Context
 Barriers faced by public institutions
 Barriers faced by private institutions
 Appendix
37
For discussion, not for circulation 
Budget and approvals process for toilets in public institutions (1/4)
Budget allocation for a toilet in a public institution is typically decided through an annual budgeting exercise across 
central, local and lower levels, considering availability of funds, and urgency across spending priorities1
The Ministry of Finance holds “Regional Budget Consultative Workshops” with local governments to 
discuss funding requirements and guidelines 1
The Ministry of Finance shares an “Indicative Planning Figure” with local governments outlining the funds 
available under different grants, and provides guidelines on how to allocate these grants 2
The relevant departments (e.g., Department of Education, Department of Health) identify required investments 
and prepare preliminary budget estimates and annual work-plans 3
The local government holds a “Planning and Budget Conference” to discuss the preliminary budget 
estimates and work-plans, and seek inputs on required investments 4
Based on the inputs received, the district administration prepares a Budget Framework Paper (BFP) and 
Development Plans (DPs) for the district 5
The Technical Planning Committee (consisting of the heads of different departments) and the local 
government Executive Committee, review and approve the BFP and DPs 6
The approved BFP and DPs are submitted to the central government for approval and are finalized, in 
parallel with the national budget, through an iterative process 7
Once the national budget is passed by the parliament, the Ministry of Finance issues the “Budget 
Execution Circular” 8
Completion date
20 August
30 September
20 October
31 October
5 November
15 November
30 November – 31 May
15 June
1. Budgeting Guidelines for Local governments 2016-2017, government of Uganda, March 2016
38
For discussion, not for circulation 
Budget and approvals process for toilets in public institutions (2/4)
 The request to construct a new toilet in a public institution can originate in two ways:
– District officials identify need for additional toilets during inspections
– The head of the public institution sends a written request to the relevant 
department
 A Technical Planning Committee inspects all applicants and prioritizes them 
according to their relative need
 The local government reviews and refines the priority list before approving it
 The DEO/ DHO chooses the desired toilet block (i.e., boys’ block, girls’ block); each 
block has a standard design
 The DE may make minor alterations to the design based on local conditions; 
these alterations do not have a significant impact on cost
 To appoint a contractor, the CAO submits a request to the procurement unit along 
with details of the toilet to be built and confirmation of funding
 The procurement unit issues a tender to a list of pre-qualified contractors 
and selects a contractor after evaluating the bids
 The management of the public institution, in consultation with the DE, selects the site 
for the toilet
 The DE approves the site and hands it over to the contractor
 The management of the public institution oversees construction on a day-to￾day basis; district officials and local government leaders periodically monitor progress
 The finance department releases payments, in installments or in a lump-sum, 
after the DE issues a certificate of completion
Process Actors involved
Various local government and administration staff are involved in approving the construction of a public institution toilet, 
overseeing construction, and approving payments
Stage
Origination 
& 
Information 
gathering
Product 
selection
Channel 
selection
Product 
Installation
 District Education officer (DEO)
 District Health Officer (DHO)
 Chief Administrative Officer (CAO)
 District Engineer (DE)
 Head of the public institution
 Local government leaders
 DEO/ DHO
 DE
 CAO
 Procurement unit
 DE
 DEO/ DHO
 CAO
 Public institution management 
committee
 Finance department
39
For discussion, not for circulation 
Budget and approvals process for toilets in public institutions (3/4)
1. Based on data collected from interviews wit
Typically, management committees of public institutions have limited say in the decision to construct a toilet, whereas the 
management committees of private institutions have much greater involvement1
The management of public schools is involved in the 
decision to construct a toilet in less than 30% of cases
Split of schools by type of stakeholder who 
decided to construct a toilet
31
29%
13%
52%
6%
Public
Schools
0%
20
60%
The management of public health facilities rarely has a 
say in the decision to construct a toilet
Split of health facilities by type of stakeholder who 
decided to construct a toilet
31
15%
68%
13%
50%
6%
13%
Public health 
facilities
0%
35%
20
0%
30%
10%
Private 
schools
0%
Management committee
Private owner/ director
Parent teacher association
Other
Government
Private health 
facilities
Private owner/ land lord
Management committee
Facility head
Government
NGO
depth research
h 31 public schools, 20 private schools, 31 public health facilities, and 20 private health facilities, during the in-
40
For discussion, not for circulation 
Budget and approvals process for toilets in public institutions (4/4)
The management committees of public institutions are also rarely involved in the toilet buying process1
Percentage of public schools where the school management was involved in 
the toilet buying process
Information 
gathering
Channel 
selection
9%
78%
0% 9%
Product 
evaluation
9%
Product
selection
56%
89%
9%
56%
27%
67% Public school
Private school
89%
Product 
installation
Issuing
payment
Percentage of public health facilities where the health facility management was 
involved in the toilet buying process
57%
13% 29% 13%
Information 
gathering
Channel
selection
0%
71%
Product 
evaluation
Product
selection
0%
Product 
installation
57%
13%
57%
13%
43%
Issuing
payment
1. Based on data collected from interviews with 11 public schools, 9 private schools, 8 public health facilities and 7 private health facilities, during the in-depth 
research. In the case of public institutions, we have considered only those institutions in which public funds were used to build the toilet. For further details 
on the budget and approvals process, please refer to the Appendix
Public facility
Private facility
41
For discussion, not for circulation 
End of document