How can MDBs improve access to WASH for persons with disabilities in Uganda?

Persons with disabilities in Uganda face accessibility barriers preventing their access to suitable water, hygiene, and sanitation (WASH). MDBs can mainstream disability inclusion and make WASH initiatives disability friendly by meaningfully engaging persons with disabilities, considering the need for disability inclusive WASH services across projects, and including disability inclusion indicators in monitoring frameworks.

Without access to safe and affordable water, hygiene, and sanitation (WASH) facilities, persons with disabilities can suffer health complications, loss of dignity, social isolation, and exclusion from school and other community activities. Although multilateral development banks (MDBs) such as the World Bank and the African Development Bank (AfDB) have worked with the Ugandan government to improve WASH access around the country, the MDBs have not systematically included persons with disabilities in WASH projects nor adequately mitigated the barriers that prevent them from accessing WASH services. To prevent the further marginalization of persons with disabilities in Uganda, MDBs and implementing ministries administering WASH projects must consider the needs of persons with disabilities and facilitate their unencumbered access to WASH services.

In BIC’s experience monitoring WASH projects, a key challenge to accessible WASH services is the lack of disability-friendly design features. For example, the AfDB’s Water Supply and Sanitation Program built water access points with the safety of women and children in mind but failed to consider disability-friendly mechanisms to extract water and safe access for persons with disabilities, especially those using wheelchairs. Due to the intersection of poverty and disability, many persons with disabilities may live in households where they are unable to afford WASH facilities in their homes. Therefore, these inaccessible water access points are particularly problematic as many persons with disabilities continue to lack access to clean water. The project also planned to build disability-friendly public toilets at institutional levels such as schools, health centers, and marketplaces — an important measure to improve the accessibility of public spaces for persons with disabilities. However, the small interior space, lack of handrails, and height of the sanitation facilities made the new facilities inaccessible. While the National Union of Disabled Persons of Uganda (NUDIPU) successfully advocated for these public toilets to be retrofitted with disability supportive devices, these changes only materialized because of a particularly responsive project task team leader. Moving forward, the AfDB and Ugandan implementing ministries need to learn from these oversights and mainstream disability inclusion in WASH projects to prevent this exclusion from occurring in the first place.  

Social stigma and institutional and environmental barriers are major challenges to disability mainstreaming in WASH projects. MDBs have a key role in working with implementing ministries to create an enabling environment that supports the inclusion of persons with disabilities in WASH projects. As the World Bank prepared a guidance note on disability inclusive WASH to design and implement inclusive projects, other MDBs like the AfDB should also formulate their own guidance note. 

Beyond the creation of an enabling environment, to improve WASH inclusive facilities for persons with disabilities in Uganda, MDBs and implementing ministries should: 

  1.  Include persons with disabilities in stakeholder engagement. Since water and sanitation issues affect the general population, MDBs need to meaningfully engage with all community members, including persons with disabilities. This will better enable MDBs to understand the barriers preventing their access to WASH and incorporate their feedback into the project design and implementation. To better include persons with disabilities in stakeholder engagement activities, MDBs should specifically reference persons with disabilities in bidding project documents with clear requirements for borrowing governments on disability issues and organize accessible consultations. These consultations need to take place during the project planning stage, before project implementation begins, as it is more costly and difficult to make changes to the project once implementation has begun. Failure to include the concerns and input of persons with disabilities in project design risks their further marginalization and exclusion from project benefits. 
  2. Consider the need for accessible WASH facilities across projects. Although WASH may not be the main focus of a project, MDBs should recognize how accessible WASH facilities could be a key accommodation allowing persons with disabilities to benefit from a project. For instance, most schools in Uganda lack disability-friendly WASH facilities preventing children with disabilities from attending school. Therefore, when designing and implementing an education project, MDBs should integrate inclusive facilities into the project design so that schools can better support the needs of children with disabilities. Similar circumstances can arise in health projects, particularly when building health clinics or quarantine facilities.
  3.  Establish disability inclusion indicators and benchmarks. Disaggregated data collection is a useful tool to measure the impact of a project on persons with disabilities, prevent them from being excluded from project benefits, and learn how future projects can be improved. MDBs should consider disability indicators such as universal access and affordability of the facility/service provided, and include benchmarks for these indicators in the project monitoring framework. Including such indicators and benchmarks within the monitoring framework enables the systematic gathering of data on projects’ impact on persons with disabilities and helps MDBs to establish inclusive and accessible WASH as the norm.

Depriving persons with disabilities of access to adequate clean water and accessible sanitation is both a denial of basic human rights of persons with disabilities and an insult to their dignity and self-esteem. MDBs and implementing ministries must work to mainstream disability inclusion across WASH projects in Uganda.