This document summarizes the Concern Worldwide Karamoja Programme in Uganda that aims to reduce malnutrition through improved health and nutrition practices. The program started in 2012 working in one parish and expanded in 2014 to cover additional parishes in Moroto, Nakapiripirit, and Amudat districts. Activities implemented include community mobilization using CLTS, providing clean water by rehabilitating boreholes, and capacity building. Key achievements include villages declared open defecation free and improved sanitation coverage, while gaps around linkages, functionality, and materials are identified along with recommendations.

1. Concern Worldwide’s Karamoja
Programme Dissemination Event
February 7th, 2017
Achunge Felix
Sanitation and Hygiene
Manager RWANU
Improved Health and
Nutrition at household
level, learning from
RWANU WaSH.

2. Introduction
• Started in Oct. 2012 as part of the original program with activities in one
parish, Nadunget sub-county, Moroto District.
• Expanded in Oct. 2014 to cover two more parishes in Moroto District, four
more parishes in Nakapiripirit and two more parishes in Amudat.
• Objective: Reduced malnutrition in mothers and children under five,
through improved health and nutrition practices at household level.
Key Activities Implemented
• Community mobilization and sensitization using CLTS approach.
• Provision of clean water through the rehabilitation of defective boreholes.
• Capacity building for sustainability.

3. Beneficiary Locations
Moroto
Nadunget sub-county reaching 7,170
people in 23 villages.
• Living in Manyattas
• Main livelihood being animal rearing, with some
business and farming
• Food insecurity leading to high dependence
syndrome
Nakapiripirit
Loregae and Nabilatuk sub-county
reaching 25,247 people in 26 villages.
• Living in Manyattas
• Main livelihood being animal rearing with some
commercial farming and business
Amudat
Karita sub-county reaching 4,735
people in 15 villages.
• Living in open homesteads
• Main livelihood being animal rearing with some
commercial farming and business
Beneficiary Locations Beneficiary Characteristic

4. CLTS Triggering
• Community Led Total Sanitation (CLTS) is an approach first used in Uganda circa 2007.
• Recognized in the 2010 National Development Plan as a low-cost approach for
mobilizing communities to stop open defecation in their villages.
• Traditionally, CLTS relies on shame, disgust and fear to stop the action of open
defecation in villages.
• In Moroto, Nakapiripirit and Amudat, several partners including district departments are
implementing CLTS and other approaches to improve on Hygiene and Sanitation (H&S)
in the villages, but up to 2015 sanitation coverage remained at 4.6% (RWANU baseline).
• In Oct 2014, the first five triggering attempts by RWANU yielded no shame, fear and
negative attitude toward change.

5. A Shift to CLTS-Plus
• First implemented by FHI 360 in Kenya, Mali and some parts of Uganda with a focus on
latrine accessibility by elderly, disabled and pregnant mothers (FHI 360 WaSH-plus, 2015)
• RWANU team adopted CLTS-plus to address the challenge of community attitude to
change, soil type, hand washing and sanitation alternatives that relate to the Karamoja
context.
Before shifting to CLTS+ After shifting to CLTS+

6. Sanitation Marketing
• An approach aimed at stimulating effective and sustainable household demand
for sanitation products and latrine services.
• In Africa, Sanitation Marketing was first implemented in Benin with over 25,000
latrines constructed across the country. In Uganda, Sanitation Marketing is
successful in Tororo District.
• In RWANU, the team started piloting Sanitation Marketing in Jan 2016 with the
aim of creating a demand for improved latrines and reducing tree cutting.

7. Rehabilitation of Defective Boreholes
• Nationally, borehole functionality has increased since 2013 - 90% target not yet
achieved.
• The functionality rate of boreholes is lower in Karamoja then in the rest of the county.
Water and Sanitation Sector Performance Report (SPR) 2016
• National functionality - 86% in 2016.
• Napak functionality - 58% to 70% in
2016
• Moroto and Nakapiripirit functionality
– 71% to 77% in 2016
• Amudat functionality – 78% to 83% in
2016

8. Factors Considered When Planning for Borehole
Rehabilitation in Karamoja
1. Groundwater distribution within the district.
2. Weather conditions.
3. Technology and skilled labour (U3 modified
or U2).
4. Livestock needs.
5. Operation and Maintenance (O&M).

9. Trainings Achieved at Community Level
• CLTS Plus, and Participatory Hygiene and Sanitation Transformation (PHAST)
targeting parish, sub-county and district officers.
• Operation and management targeting Water & Sanitation Committees.
• Pit excavation and latrine slabbing targeting youth (masons).
• Tippy tap installation and operation, targeting Lead Mothers.
• Pit latrine construction targeting RWANU Health Promoters and Health Educators.

10. Lessons Learnt
• Innovation of existing WaSH approaches is necessary in Karamoja for good
results.
• Strategies that work in one district may not work in another in Karamoja.
• CLTS follow-up to Open Defecation Free (ODF) declaration takes between 10 to
12 months, as opposed to 6 month in other areas.
• Triggering over 60 villages in one quarter leads to low ODF achievement.
• Involving elders improves community attitude towards change.

11. Key Achievements
• Being the first to declare villages open defecation free in the three districts; four
villages declared ODF and four more are undergoing verification.
• General improvement in sanitation coverage; Moroto increased from 3.6% to
10.7% (district report, 2016).
• Community repairing their boreholes; communities were responsible for the
maintenance costs of four boreholes requiring repairs.
• Adoption of sun-baked block technology; more than half of the villages in Loregae
sub-county have structures made of blocks.

12. Gaps and Recommendations
Gaps Recommendations
Linkages between WUCs, HPMs
and district supply stores
• Train and link HPMs to WUCs and district water office
for spares and regulation of charges.
Hygiene and sanitation status • Integrate H&S to all activities including Care groups.
• Consider home improvement campaign in ODF
villages, CLTS-plus in non triggered villages and
CHAST for schools pupils.
Functionality of boreholes • Introduce vegetable growing to water source
management.
• Rehabilitate boreholes on a need based strategy.
• Solar motorized scheme for Loregae and Karita.
Construction materials, poles and
grass.
• Scale-up use of sun-baked block to improve on pit
latrine structure while promoting cat sanitation in
areas with loose soil structure.
Community ownership and high
demand for subsidy
• Involve, elders and other community leaders in
advocacy

13. Thank You