The project targets activities in low-income areas and vulnerable groups. This is achieved through the zoning of urban areas using a composite matrix of socio-economic status, demographic data and water supply availability and use.

The programme has implemented a longitudinal studies of point water source quality, based on initial assessments of quality. Given the intensity and variability of pollution in urban areas, the differing population densities within and between towns and a rainfall pattern which shows less pronounced seasonality than some other tropical countries, existing guidance of sampling frequencies for such supplies was not deemed adequate. The longitudinal study will provide local authorities with better guidance on sampling frequencies in different parts of urban areas. The sampling frequency for piped water is based on initial assessments and on population served. Each urban piped system is being zoned to provide a more effective sampling programme. Data is stored on dedicated software developed by the project which links sanitary inspection and water quality data through a relational database. Communities are brought into the process of monitoring through reporting and feedback mechanisms operated by the local public health staff. In addition, materials are being developed to assist communities in monitoring their water supplies. Much of the focus on improvement of supply has focused on community-based actions such as mobilising resources for piped water connection and improvements in operation and maintenance of point water supplies. In addition, local authorities are assisted to identify problem areas and appropriate approaches to improving water supply. Health education materials to support a national PHAST programme have been developed aimed at ensuring a safe water chain for communal source users.

An investigation into a methodology for differentiating between human and animal faecal contamination was carried out in late 1999 and has been shown to be effective and therefore provides health authorities and suppliers with additional tools in identifying preventative and remedial action.

The project is now entering a further field testing stage in order to evaluate the usefulness of the approaches and tools developed. Testing will be undertaken in Bangladesh in collaboration with WHO/SEARO and in one African country with collaboration with WHO/AFRO. The experiences will be consolidated with those gained from other pilot projects and professional experience will be included. into a final set of manuals. A Web site has been set up to allow easy access to all the material currently developed.

In most towns, the pattern of water availability and use is complex with a relatively low number of household connections to piped water. The unserved population utilises a mixture of public standpipes, purchase from neighbours with piped water connections, point sources (protected springs and boreholes) and unprotected sources. In towns covered by the utility supply, the majority of sources available are piped, primarily from individuals who sell water from household connections, although point sources may represent up to 40% of available sources. A pilot water usage study in Kampala indicated that 60% of the urban poor utilise piped water as their source of preference, although the majority of households utilise 2 or more sources (with protected springs being the principal subsidiary source). Vendor usage is relatively common (water is collected from protected springs) but seems greater amongst higher-income households who can afford the cost of this water.

Costs of water purchased from neighbours indicates that the household collecting this water pay up to 10 times as the charge levied on public standpipes and up to 7 times the unit cost of water supplied through a household connection. The analysis of cost of water supply has shown that unit costs should be affordable to most people in the country. However, it appears likely that the capital investment in terms of connection fees and payment for materials for connections may be a major barrier to connection, particularly at a household level. In addition, there appear to be doubts regarding the reliability of NW&SC billing procedures. Disconnection from water supply remains an issue of concern for both households and communities operating communal standpipes and this reflects a lack of balance between billing structures and income patterns. Staff working on the surveillance project are working with communities to explore problems caused by cost and a contingent valuation study is being planned to assess these issues more fully.

In towns with a Municipal water supply, point sources or community-managed gravity-fed piped water supplies are the most commonly available sources, reflecting the greater problems in the supply of water the Municipal Councils face. The ongoing work of the project has meant that water quality and water supply are maintaining a high profile. The field staffs in Municipal Councils are now required to provide monthly summaries of water quality in their Division by their Head of Department and Town Clerks. A reporting framework has been developed for information feedback to communities including whether faecal contamination is present, major risks identified and recommendations for action. There has been a great demand for such information and although it is not possible to provide information for every individual user, Public Health staff provide reports to community leaders and attend community meetings to provide information on water quality. Reports are also prepared for NW&SC who have reciprocated with their results.

The routine data collected from Kampala indicate that the quality of the piped network is generally good with respect to microbiological quality, with an average monthly compliance with 0FC/100ml of over 97%. However, reported discontinuity is high in some areas and free chlorine residuals are inadequate in some areas. Failures in microbiological quality tend to be due to localised problems, usually within the customer mains. Where water quality failures have been found, rapid action has been possible by Public Health staff to rectify the problem by working with users.

Protected springs are being routinely monitored to assess temporal fluctuations and to provide a data set from which to identify major problems. The sanitary inspection data collected indicates that the major problems relate to sanitary completion and urgent attention is required to improve such sources because of their high level of use both directly by households and indirectly through purchase of vendor water. The project is now using this data, along with information about the piped network to develop a strategy for water supply improvement in Kampala. In addition, to existing data, a water supply vulnerability index will be used to define high risk areas based on the zoning concepts already used by the project.

The community-based work in Kampala has already yielded results as each community met has identified priorities and discussed ways of monitoring and managing water supplies. Most have identified the improvement of protected springs as the major priority, although there is some interest in accessing piped water through public tapstands in one or two communities.

The analysis of data from NW&SC has yielded useful information about the adequacy of the piped water network in Kampala. At present, there are concerns about the overall bulk distribution coverage which appears to limit access in some low-income areas, particularly as the distance to supply mains may substantially increase connection costs.

The use of socio-economic and demographic data has allowed the project to target those populations at greatest risk from water-borne disease and has ensured that testing of all sources used has been carried out.

The role of local health bodies in surveillance of water supplies has now been included in the draft minimum health services package in Uganda and there is an increasing demand from communities and health bodies to be able to gather water quality data as a way of assessing the priority communities within their administrative areas.

Howard, G and Luyima, P. (1999). Urban water surveillance in Uganda, in Pickford, J (ed), Integrated Development for Water Supply and Sanitation, Proceedings of the 25th WEDC Conference, Addis Ababa, 1999, pp290-293.

Bartram, J. and Howard, G (1999). Safe water in the Commonwealth in Health in the Commonwealth: Challenges and Solutions, Kensington Publications and Commonwealth Secretariat.

Howard, G., Bartram, J.K. and Luyima, P.G. (1999). Small water supplies in Urban Areas of Developing Countries. Proceedings of the Symposium on the Economics, Technologies and Operations of Small Water Systems. Washington, D.C.

Tel: +44 1509 228309
Fax: +44 1509 211079
Email: a.g.howard@lboro.ac.uk

RCPEH
Steve Pedley
Robens Centre for Public & Environmental Health
University of Surrey
Guildford GU2 5XH

Tel: +44 1483 259281
Fax: +44 1483 259971
Email: s.pedley@surrey.ac.uk