Why the water and sanitation sector in East Africa
should consider disabled people
Country Note highlights key challenges disabled
people living in East Africa face in accessing water
and sanitation services. It also identifies
how the water and sanitation sector can help to
improve the situation.
by: Gerald Rukunga, David Mutethia and Titus
Kioko of AMREF
Edited by: Frank Odhiambo, WEDC
Current estimates are that approximately 7.3
million people in East Africa are disabled.
Violent conflict, accidents, HIV/AIDS and
environmental pollution, all of which are common
in East Africa, contribute to an increase in the
number of disabled people.
Disabled people have the same needs and rights
as everyone else, including access to
adequate living conditions, sanitation
facilities and safe water, education and health
The majority of disabled people in low income
communities will only access these basic needs
and rights and achieve an acceptable quality of
life, by being included in mainstream services
Lack of clean water and sanitation facilities
are key factors in keeping people poor,
unhealthy and unable to improve their
livelihoods. For disabled people the
impact is far greater.
Areas with least access to water and sanitation
also tend to have a higher percentage of
disadvantaged population, including disabled
Disabled people are naturally excluded from
water and sanitation projects in low-income
communities because project designs do not
consider their needs.
Barriers in Accessing Water Supply
Barriers exist in the natural environment, like
long distances to water sources, rough terrain,
rivers with soft or rocky banks and uneven
slopes to reach the water. These all impede
access for those with physical impairments,
especially in rural areas.
Physical infrastructure barriers include steps
to reach a water source, slippery floor surfaces
and apron walls. In the household, narrow
doorways, water storage containers without
handles, or out of reach make it difficult for
disabled people to access water.
In times of acute
water scarcity, people queue for long hours at
water points. Water for use by disabled people
can become a low priority, partly due to the
belief that they do not get so dirty due to
their limited physical activities.
and sanitation policies and strategies in Kenya
strongly advocate for provision of water to the
poor and vulnerable populations. Disabled people
fall within this group, but their concerns are
not given the due prominence they deserve.
Despite the policy provisions, there is an acute
lack of appropriate and available information to
enable implementers to adapt water and
sanitation facilities in a way that addresses
the challenges faced by disabled people.
Disabled people face stigmas and exclusion
resulting from limited knowledge and
understanding on the causes of disability. This
can be particularly acute where disability is
associated with witchcraft or curses. Disabled
people may be prevented from sharing communal
facilities for fear that they will “contaminate”
the water, or make the facility “dirty” for
Disability and Access to Sanitation Facilities
Improved Pit (VIP) latrines are commonly used
throughout East Africa. Where they have been
adopted, communities are considered to have
increased access to sanitation. This may not
reflect reality however, since the design of
most VIPs makes them inaccessible to disabled
Problems disabled children face in a Ugandan
Children using wheelchairs in a Ugandan primary
school can find toilet access and use
problematic. Kiwanuka (2002) reports that these
children have difficulty opening the doors and
closing them once inside. Door locks are often
too high to reach and limited space inside the
latrine restricts movement. Taps are often too
high, making hand washing and self-cleaning
problematic. Children who crawl find the floor
too dirty, especially as they often crawl with
bare hands. Where the water source is not close
by, users find it difficult to carry water to
the latrine for washing.
Why Prioritize Provision of Water and Sanitation for
Improving access to water supply and sanitation
services for disabled people also benefits care
providers, usually women and girls, by reducing
their workload and freeing them to undertake
other activities, such as attending school or
earning an income. Savings from medical costs
and time spent on care-giving can also be
invested by the family in other socio-economic
marginalized groups can benefit from accessible
facilities, including elderly people, pregnant
women, children and the sick, including those
living with HIV/ AIDS.
Making Water and Sanitation Facilities Accessible to
sources should ideally be located near to
households where disabled people live. This may
mean providing piped water next to the house, or
installing a storage jar nearby. A wide, level
path may also need to be provided, leading to
the facilities, so that someone using a
wheelchair or walking with support can have
to a tap or pump handle is particularly
important for people who have impaired use of
their lower limbs. A ramp or sitting block may
need to be provided, to ensure access.
means of transporting water, such as jerry cans,
should be adapted in such a way as to be
convenient for the user.
Toilets should be constructed with appropriate
access facilities. Examples include ramps to
reach raised toilets, ways to allow disabled
people to open, close and lock doors and
non-slip floor surfaces.
Installing raised toilet seats and handrails can
provide support to disabled and elderly people
who are unable to use a squat latrine.
In Kenya, the Persons with
Disability Act 2003 is the main legal instrument
that comprehensively addresses the rights of
disabled persons. It covers, for example access to
buildings, public carriages and education
opportunities. However, accessibility to water and
sanitation services has not been clearly defined in
Uganda, promoting equal opportunities for people
with disabilities has been identified as a
strategy to reach marginalized people. Despite
this, no specific guidance is available on
how to achieve increased access to water and
sanitation services for disabled people.
Community Based Rehabilitation [CBR] is the main
strategy adopted in Kenya and Uganda to address
the needs of disabled people at the community
level. However, the major emphasis is on raising
awareness to reduce social stigmas, rather than
on improved service delivery by, for
example, integrating the provision of water and
sanitation into the strategy.
Although disability is considered a human rights
issue, concrete plans are yet to be developed to
improve access to essential health care
programmes. In Uganda for instance, primary
health care activities have been implemented for
more than two decades, but little attention was
paid to disability issues prior to 1995.
Relevant and appropriate information on how to
develop inclusive water and sanitation
facilities is crucial, if sector stakeholders
are to address the current barriers faced by
disabled people in accessing services.
Disability and Gender-related Burdens
spent on care-giving tasks reduces time
available for other household tasks such as
growing food for the family, or for leisure,
educational or fee-earning activities.
Leonard Cheshire International, a charitable
organization, has been providing services that
support disabled people and their right to
participate fully in society. The organization
is implementing a pilot project on Inclusive
Education in five schools in Western Kenya. A
key component of the project is environmental
the project, disabled school children had
difficulty accessing water and sanitation
facilities, which were old and poorly
maintained. The floors of the latrines were
caving in, posing great risks to all children,
while those with disabilities were totally
unable to use them.
Through community participation, adaptations to
the school latrines have been made by pupils,
teachers and the community. The latrines have
been rebuilt and made accessible by providing
concrete access ramps, wide entrances and toilet
pedestals. The toilets are also equipped with
supporting handrails or chains.
Together with other environmental adaptations,
the project has helped to improve education for
all of the children, while the school enrolment
of children with disabilities has increased by
113% in three years.
Belgium Technical Cooperation and AMREF Kenya.
(2002). Assessment of Reproductive Health Needs
of Persons with Disabilities in Makueni
District, Kenya, African Medical Research
Foundation, Nairobi, Kenya.
Government of Kenya. (2003). People with
Disabilities Act 2003, Government Press,
Government of Uganda. (2005). Poverty
Eradication Action Plan (2004/5-2007/8),
Ministry of Finance, Planning and Economic
Development, Kampala, Uganda. Available at:
Government of Uganda. (1999). Essential Services
for Rehabilitative Health Care for Persons with
Disabilities in the District, Ministry of
Health, Kampala, Uganda.
(2003). Governance and Financing of water
supply and sanitation in Ethiopia, Kenya and
South Africa: A Cross Country Synthesis,
Water and Sanitation Program – Africa Region,
Nairobi, Kenya. Available at
H. and Reed, B. (2005). Water and Sanitation
for Disabled People and Other Vulnerable Groups:
Designing services to improve accessibility.
Loughborough University, Leicestershire, LE11
Note is based on the WELL Global Briefing Note
series. These and other Country Notes are
further information contact:
Medical and Research Foundation (AMREF)
Road, Wilson Airport,
Box 30125 - 00100
Phone: 0(254) 20 6994352
Fax: 0 (254) 20 602531/606340
Water, Engineering and
Development Centre (WEDC)
Leicestershire LE11 3TU, UK
+44 (0)1509 228304
+44 (0)1509 211079
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