Kwiringira et al. BMC Public Health (2021) 21:992 https://doi.org/10.1186/s12889-021-11029-8 RESEARCH ARTICLE Open Access Re-conceptualizing sustainable urban sanitation in Uganda: why the roots of ‘Slumification’ must be dealt with Japheth Nkiriyehe Kwiringira1* , Robert Kabumbuli2, Henry Zakumumpa3, James Mugisha1, Mathias Akugizibwe1, Paulino Ariho1 and Joseph Rujumba4 Abstract Background: Country-wide urbanization in Uganda has continued amidst institutional challenges. Previous interventions in the water and sanitation sector have not addressed the underlying issues of a poorly managed urbanization processes. Poor urbanisation is linked to low productivity, urban poverty, unemployment, limited capacity to plan and offer basic services as well as a failure to enforce urban standards. Methods: This ethnographic study was carried out in three urban centres of Gulu, Mbarara and Kampala. We explored relationships between urban livelihoods and sustainable urban sanitation, using the economic sociology of urban sanitation framework. This framework locates the urbanization narrative within a complex system entailing demand, supply, access, use and sustainability of slum sanitation. We used both inductive and deductive thematic analysis. Results: More than any other city in Uganda, Kampala was plagued with poor sanitation services characterized by a mismatch between demand and the available capacity for service provision. Poor slum sanitation was driven by; the need to escape rural poverty through urban migration, urban governance deficits, corruption and the survival imperative, poor service delivery and lack of capacity, pervasive (urban) informality, lack of standards: ‘to whom it may concern’ attitudes and the normalization of risk as a way of life. Amidst a general lack of affordability, there was a critical lack of public good conscience. Most urbanites were trapped in poverty, whereby economic survival trumped for the need for meeting desirable sanitation standards. Conclusions: Providing sustainable urban livelihoods and meeting sanitation demands is nested within sustainable livelihoods. Previous interventions have labored to fix the sanitation problem in slums without considering the drivers of this problem. Sustainable urban livelihoods are critical in reducing slums, improving slum living and curtailing the onset of slumification. Urban authorities need to make urban centres economically vibrant as an integral strategy for attaining better sanitation standards. Keywords: Urbanization, Urban livelihoods, ‘Slumification/slumify’, Urban poverty, Sustainable urban sanitation, Uganda * Correspondence: [email protected] 1Department of Sociology and Social Administration, Kyambogo University, Kampala, Uganda Full list of author information is available at the end of the article © The Author(s). 2021 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Kwiringira et al. BMC Public Health (2021) 21:992 Page 2 of 12 Background An outlook at Uganda’ urbanization Poor sanitation is a major indicator of urban poverty In Uganda, 24.36% of the total population lives in cities and poor health [1, 2]. Squatter settlements that are and urban areas with a population growth rate of 3.3% common in urban areas are frequently attributed to pov- [43]. Kampala is Uganda’s oldest city and constitutes erty [3, 4]. Compared with their high-income counter- about 25% of the country’s total urban population. In parts, low-income countries are disproportionately Uganda, about 60% of the urban population (represent- affected by slum settlements [1, 4–6] . In addition, urban ing about 18% of the total population) live in slums and areas in the global south are associated with higher pov- informal settlements [43], with pervasive unemployment erty [7, 8]. The high rate of urban poverty in Africa has and congestion [44]. Both individual and institutional not reduced the region’s rate of urbanization [4]. In fact, factors sustain the slum experience in Uganda. Kampala the growing urbanization is partly attributable to poor city is the most affected by unplanned and unsustainable economic performance and bad governance in rural urbanization. Mbarara city, the biggest (administrative areas [9, 10]. Post-independence Uganda has been char- and business) urban centre and transport hub in the acterized by declining economic growth, low productiv- western region has been under pressure from rural pop- ity, conflict [11, 12] and governance deficits. The later ulations that migrate to seek employment to escape low have negatively impacted urbanization [13, 14] coupled wages and poor performance of rural agriculture. The with poor urban service delivery [15]. Admittedly, while urbanization of Gulu [45, 46] was partly driven by the colonial planning frameworks [16] had their weak- people fleeing the two decade brutal civil war between nesses and biases replete with racism, the post-colonial the Government of Uganda and the rebels of the Lord’s institutional decay [17] further accelerated the collapse Resistance Army -LRA [47, 48]. For northern Uganda, of the economy and increased the national debt with the the humanitarian crisis [11, 49] resulting from this con- resultant collapse of urban services including sanitation. flict had long- lasting impressions on the urbanization of Urbanization involves populations moving from rural Gulu which continues to host those that seek an urban to urban centres and the re-organizing of activities that dividend [50, 51]. Gulu town has also been host to those lead to permanent urban residence [18]. Sustainable fleeing conflict from neighboring Sudan, South Sudan, urbanization continues to present a major challenge to Eritrea and Somalia as well as those affected by hunger urban authorities across the world [19, 20]. In Sub- in Northern Uganda [52]. Overall, lack of a robust in- Saharan Africa, post-independence urbanization has dustrial sector and employment opportunities have had been a haphazard process that has exacerbated urban negative consequences that partly explain the persistence poverty [1, 2, 21–24]. Urbanization in Uganda has con- of slum conditions [53]. tinued unabated due to well-known push and pull fac- tors [22, 25] amidst economic stagnation, inequality and Theoretical framework urban decay [26, 27]. This context, continuously makes Drawing on the economic sociology [54–56] of urban most urban residences unsuitable for human habitation sanitation, we explored relationships between urban live- [28] due to congestion, poor housing, poor service delivery lihoods and sustainable urban sanitation in Uganda. Eco- including water, sanitation and hygiene [29, 30]. nomic sociology relates to how material conditions of Urbanization in itself is a progressive process as was the life are produced; and reproduced through social pro- case in the first city states of Sparta, Mesopotamia and cesses, including the production, supply, demand, and Athens, that were centers of civilization and thinking,high consumption goods and services [57], structure and dy- productivity and innovation [31–33]. Cities have been hot- namics [58]. There have been no studies exploring the beds of democracy, good governance [33, 34]andbetter linkages between unsustainable urban sanitation and un- infrastructure [35]. Good urban services tend to enhance sustainable urban livelihoods. the progress of communities [36, 37]. Such is the outlook to the city as an economy and polity [38, 39]. This appears Methods to be a missing in Uganda’s urbanizing agenda. Urban Study design and setting sanitation conditions in Uganda are deplorable [24, 40, An ethnographic [59, 60] study was conducted in Gulu 41]. Sanitation choices available to the urban poor are lim- (Bar-Dege and Pabo zones), Mbarara (Mandela and ited onsite facilities that are shared by up to 30 individuals Kiyanja zones) and Kampala (Ddobi and Kisasiizi zones). or 7 households, with private sanitation being a privilege Study sites were purposively selected through reconnais- for a few house owners [40]. Studies have shown that, sance and ranking by Key informants. Kampala is the shared sanitation facilities in slums are abandoned after a largest and national capital with the most slums. Mbarara short time [29, 42]. This is made worse by the fact that was selected on account of being the regional capital in the cost of an improved sanitation facility exceeds the an- the western region as well as having the largest number nual per capita income of many slum dwellers [40]. of slums after Gulu. Participants