Uganda Sanitation for Health Activity (USHA)

During World Toilet Day celebrations, the BRAC women hold sanitation products, such as SATO pans. Photo credit: Dorothy Nabatanzi

Activity Description

From 2018 to 2023, the USAID-funded Uganda Sanitation for Health Activity (USHA) worked to improve access to safe and sustainable water, sanitation, and hygiene (WASH) services in 20 districts across three regions. Through a series of integrated WASH interventions at the district, community, and household levels as well as national-level policymaking, USHA’s work aligned with the Government of Uganda’s Integrated Sanitation and Hygiene Pillars to achieve three key outputs:

  1. Increased household access to sanitation and water services  through improving supply chain and strengthening rural utilities.
  2. Spurred demand for the adoption of key hygiene behaviors in homes, schools, and health facilities. 
  3. Strengthened the enabling environment for enhancing district water and sanitation governance to improve the sustainability of newly improved services.


  • Coordinated with national and district-local governments, community-based and civil society organizations, and the private sector, to pilot market-based sanitation approaches to stimulate demand for improved toilets, strengthen business services to market and diversify sanitation product options, and enhance local sanitation supply chains. In total, 137,969 households invested in basic sanitation (newly constructed or upgraded toilets) through a variety of delivery models. 
  • Worked with fecal sludge management entrepreneurs in urban areas to improve their business operations and increase the volume of sludge collected and transported for safe treatment; piloted leasing government-owned cesspool trucks to private fecal sludge management entrepreneurs. 
  • Piloted pro-poor tariff and target subsidies with rural utilities to deliver first-time on-premises access to piped drinking water to 1,400 households, including 700 households within the bottom 40 percent by national wealth quintile. 
  • Adapted a traditional community-led total sanitation approach in seven northern districts by integrating aspects of market-based sanitation to trigger the household engagement process, resulting in a doubling of access to basic sanitation and the verification of nearly 2,000 villages as open defecation free.
  • Collaborated with 114 schools and 10 healthcare facilities to make them “WASH friendly” by introducing infrastructure improvements such as improved water supply, new handwashing facilities, and improved toilets. Complementary capacity-strengthening and awareness-raising efforts trained community members on the proper maintenance, management and budgeting for O&M, and use of the facilities.
  • Provided targeted technical assistance to strengthen governance. At the district level, USHA provided in-kind grants and implemented targeted capacity strengthening efforts to support district local governments to operationalize national guidelines and policies, improve coordination, and strengthen their leadership and advocacy for improved sanitation and drinking water within their communities. At the national level, USHA utilized a collective action approach to support Uganda’s Ministry of Health and Ministry of Water and Environment to draft and subsequently adopt National Sanitation Market Guidelines. 

Related Links 

Activity Status
2018 - 2023
Prime Implementing Partner
Funding Level
Award Number