Health
Uganda has until 2030 to end Open Defecation as Ntaro’s PhD Examines Kabale’s Progress
Silhouettes slip along narrow paths, farmers heading to their gardens, women balancing yellow jerrycans on their hips, children in oversized sweaters hurrying to school, and herders steering cattle toward open pasture, each movement part of a choreography older than memory. This is a quiet ritual in Kabale’s terraced hills, moments before the sun lifts.
The quiet procession to ahakashaka, or omukishaka, often sees figures moving quickly along familiar footpaths in the half-light, as children and adults walk with the urgency of habit. It is not a stroll but often a small, hurried run before daylight exposes what should be private.
It is February 2026, and the century-old Makerere University is celebrating its 76th Graduation Ceremony. The world paces and races toward artificial intelligence and digital revolutions. But some families still begin their day by rushing to the bushes for relief and concealment, while others engaged in economic activities such as gardening and grazing have no sanitation option other than using their surroundings to respond to the nature call!
The deadline to end open defecation is 2030. The science is settled, and the commitments are written into Sustainable Development Goal 6. Yet in parts of Kabale, only a small fraction of households is truly open defecation free.
In his PhD research, Dr. Moses Ntaro did not start with global targets or conference declarations. He began where the morning run ends, at the edge of the compounds, behind banana stems, along worn paths leading to Omukishaka. He asked whether students, equipped not with bricks but with conversation, follow-up, and persistence, could help communities replace that dash with something quieter: a door that closes.
What he found is both hopeful and unsettling. Change is possible. But dignity, like sunrise, should not require a run. And with 2030 approaching, time is no longer generous.
The Question That Would Not Let Him Go
Ntaro did not encounter open defecation as a statistic. While on foot and serving as Assistant Coordinator of Community-Based Education at Mbarara University of Science and Technology (MUST), he learned while supervising students placed in rural communities across southwestern Uganda. They walked villages together, conducted transect walks… and they observed.
“In my role as academic coordinator,” he explains, “students always took me on transect walks within the villages to show me how high open defecation practice was. The effect was evident in the high prevalence of intestinal infections we saw in health facility records.”
The link between sanitation and disease was not theoretical but visible in clinic registers. Diarrhea, intestinal worms, recurring infections among children, and more were all visible in the clinic registers.
Nineteen years ago, in 2007, Uganda adopted Community-Led Total Sanitation (CLTS), a strategy designed to trigger collective behavior change and eliminate open defecation. Progress, however, remained uneven. That same year, Ntaro was working as an Environmental Health Officer with the Water and Sanitation Development Facility under the Ministry of Water and Environment. He was three years away from completing his Environmental Health degree at Makerere University School of Public Health.
And so, the question emerged, to Ntaro, that, ‘If students are already embedded in these communities through COBERS placements, why are we not intentionally harnessing them to accelerate sanitation change?’
That question became his PhD.
This is a Crisis That Should No Longer Exist
Globally, more than 350 million people still practice open defecation. Sub-Saharan Africa carries a disproportionate share. SDG 6, specifically Target 6.2, commits the world to ending open defecation and ensuring universal access to safe sanitation and hygiene by 2030. It prioritizes women, girls, and vulnerable populations. It speaks of dignity, of safely managed services, and of disease prevention.
We are four years away from that deadline. And in rural Kabale District, somewhere in southwestern Uganda, Ntaro’s research found that only 3 percent of households were truly open defecation-free.
Yes, three percent. His 2025 BMC Public Health study examined 492 residents. The average age was 49. Nearly 30 percent had no formal education. Most were women, the custodians of household hygiene and child health.
The determinants of Open Defecation Free (ODF) status were deeply behavioral.
Male-headed households had higher odds of being ODF. Households with clean compounds, clean latrine holes, and consistent handwashing practices were significantly more likely to sustain sanitation improvements.
Sanitation, Ntaro realized, is not only infrastructure but also power, memory, habit, and social expectation.
“Factors associated with ODF status were not just economic,” he notes. “They were behavioral and contextual.”
Why It Feels So Wrong to Still Discuss This
Talking about open defecation in 2026 feels unsettling for three reasons. First, it feels like a failure of basic dignity.
Think of an era of global connectivity and rapid technological advancement, and hundreds of millions still lack privacy. For women and girls, this exposes them to harassment, exploitation, and fear. Sanitation is not just about disease but safety.
Second, it feels like an avoidable health crisis. One gram of feces can contain millions of viruses, bacteria, and parasites. Open defecation directly fuels cholera, typhoid, diarrhea, and environmental enteropathy, a silent contributor to child malnutrition and stunting. The science is settled, and yet the practice persists.
Third, it feels like a poverty trap. Illness leads to lost productivity; lost productivity deepens poverty, and poverty limits investment in sanitation. The cycle continues.
“Open defecation is not simply a sanitation issue,” Ntaro says. “It is linked to poverty, nutrition, and broader development.”
Testing a Different Approach
Ntaro’s doctoral thesis, “Effect of Student Community Engagement on Open Defecation-Free Status,” tested whether health profession students could effectively facilitate Community-Led Total Sanitation.
In some villages, traditional Health Extension Workers led the sanitation process. In others, trained students facilitated it under the COBERS (Community-Based Education, Research, and Service) model, which places medical trainees in community health facilities to learn through real-world practice, bridging classroom theory with primary care and public health work in rural settings.
Through this model, students led triggering, follow-ups, and community engagement. Open defecation declined. More households achieved Open Defecation Free status. And the cost per household was lower than in traditional approaches.
“Students were more effective,” Ntaro explains. “More households became open defecation-free compared to the traditional approach. And they were a cheaper human resource.”
But cost was not the real breakthrough. Presence was. Students stayed for weeks. They returned to check on latrines. They built trust. They kept coming back. Because sustainability, Ntaro argues, is not built in a single visit. It is built in repetition.
“There is a need for continued follow-ups and continued student engagement if long-term impact is to be realized.”
Change cannot be declared once and forgotten.
Behavior… and Not Just Bricks
Using the RANAS framework, Ntaro found that households that remembered to wash hands and kept latrines clean were far more likely to sustain Open Defecation Free status. In sanitation, behavior leaves evidence.
“Behavioral change interventions that empower communities,” he recommends, “such as CLTSH, should be strengthened to increase households with ODF status.”
In other words, building latrines is not enough, but communities must believe in them.
The Defense and the Countdown
On December 11, 2025, Ntaro defended his PhD. Examiners pressed him on scale and sustainability. Could student engagement be institutionalized? Could universities be embedded in district sanitation planning?
His answer was pragmatic: “Yes, but community-based education must be included in planning and budgeting.”
Four years remain to meet SDG 6.2. Four years to end open defecation and turn dignity from promise into practice. In 2026, this conversation should feel outdated. Instead, it remains urgent.
The Slow Work of Restoration
In Kabale, progress does not look dramatic. It looks like a latrine door closing firmly behind someone, a handwashing station with water and soap, a compound swept clean. It looks like a child who does not fall ill this month. Public health victories are often quiet.
As Makerere University approaches its 76th Graduation Ceremony, Dr. Ntaro Moses stands among its PhD graduands not with theory alone, but with evidence that change can be accelerated by reimagining who leads it. Students, he shows, are not only learners. They are the workforce, facilitators, and bridges between policy and path.
The hills of Kabale still wake under mist. But in more compounds now, privacy exists where bushes once stood open. Dignity is not restored in headlines, but one household at a time.
And with 2030 approaching, Ntaro’s work leaves a final, unavoidable question: if we already know how to end open defecation, if we already have the tools, the evidence, and the people, what, exactly, are we waiting for?
— Makerere University School of Public Health Communications Office, Graduation Profiles Series, 76th Graduation Ceremony
Health
MakCHS 2026 Orientation begins: Freshers Urged to Prioritise Responsibility, Integrity and Academic Excellence
New students joining Makerere University College of Health Sciences (MakCHS) have been urged to embrace responsibility, discipline, integrity and hard work as they embark on their journey towards becoming healthcare professionals.
The call was made during the opening session of the college’s orientation programme that began on the 4th August and will conclude on 7th August 2026. During the session, College leaders including the Principal and Deans welcomed students admitted to study various programmes at MakCHS. The speakers outlined expectations for academic and professional conduct.
The session was moderated by Professor Mark Kaddu, Deputy Dean-School of Medicine. Welcoming the freshers, he stressed the importance of hard work highlighting that ‘your academic documents will speak for you and excellence will open doors’.
The college leaders congratulated the students on securing admission to Makerere University, noting that many qualified applicants were unable to secure places. They encouraged the new entrants to make the most of the opportunity by committing themselves to excellence from the first day. The students were reminded that programmes offered by the college are rigorous full-time courses that demand commitment, discipline and consistency.
In his remarks, Professor Bruce Kirenga – Principal, MakCHS welcomed the new entrants and provided an overview of the College’s rich history, highlighting its growth and commitment to excellence in health professionals’ education. The Principal reaffirmed the college’s mission of impacting the national health agenda through transformational teaching, research and innovation for societal development. Students were encouraged to embrace the wide range of career pathways and professional opportunities available upon qualification, emphasizing that their training would equip them to make a meaningful contribution to society.
Stressing the importance of mind-set change which has also been introduced as a crosscutting course, the Principal urged the students to cultivate discipline, resilience, professionalism, and a passion for lifelong learning. “The journey you have embarked on is challenging, but it is achievable,” the Principal noted, reminding the students that many graduates before them successfully completed the programme through dedication and hard work. The address concluded with a call for the new students to remain focused, work diligently, and strive for academic excellence as they prepare to become the next generation of healthcare professionals who will transform their communities.
Professor Annettee Nakimuli, Dean – School of Medicine encouraged students to work collaboratively rather than viewing learning as a competition. She urged them to form productive study groups, support one another and take advantage of opportunities for mentorship, research and international exchange programmes available through the college. “We are here to support you throughout your journey,” she told the students, adding that strong academic performance could open doors to international exchanges, postgraduate training and research collaborations with universities around the world.
Professor Nakimuli warned students against academic dishonesty, including examination malpractice, falsification of academic records and illegal programme changes. She cautioned that such misconduct could lead to dismissal from the university, even after several years of study. Students were further advised to be vigilant against fraudsters who promise to alter admission records or transfer students into different academic programmes through unofficial channels.
In his remarks, Dr. Richard Muhindo, Dean-School of Health Sciences highlighted the importance of personal responsibility and wellbeing beyond academics. He encouraged students to manage their time wisely, avoid drug and alcohol abuse, stay away from gambling and maintain healthy lifestyles throughout their studies. Dr. Muhindo emphasized the importance of professionalism, reminding students that healthcare careers are built on compassion, teamwork and service to humanity. He encouraged students from different programmes to learn together, respect one another’s professions and build networks that will benefit them throughout their careers.
In his address to the freshers, Dr. David Nono who represented Dr. Annet Kutesa, Dean – School of Dentistry, encouraged students to embrace the opportunities before them by working hard, maintaining discipline, and striving for academic excellence. He emphasised the importance of achieving a strong academic record, noting that outstanding performance opens doors to competitive opportunities and future specialisation. The Dean also urged students to pursue postgraduate studies, reminding them that the dental profession requires highly qualified specialists. Reflecting on his own academic journey, he shared how dedication and continuous learning enabled him to study and work internationally before returning to serve the University. He concluded by encouraging students to remain focused, respect University rules, support one another, and make the most of their time at the institution as they prepare for successful professional careers.
Representing the Dean of the School of Biomedical Sciences, Professor Elisa Mwaka welcomed the freshers and congratulated them on earning admission to the College, urging them to embrace responsibility and discipline as they begin university life. Introducing the School of Biomedical Sciences to students, he explained that it handles core foundational courses like Physiology, Biochemistry, Pathology, Medical Microbiology, Immunology, Molecular Biology, among others that support their academic journey. Professor Mwaka reminded students that success at university depends on personal responsibility, regular class attendance, effective time management, and organised study habits, emphasizing that attendance of at least 80 percent of lectures and practical sessions is required to qualify for examinations. He also encouraged students facing academic or personal challenges to seek guidance from their lecturers early rather than waiting until examination time, and urged them to be punctual, prepare adequately for classes.
Mental health featured prominently during the orientation. Leaders acknowledged that health sciences programmes can be stressful encouraging students experiencing emotional or psychological challenges to seek support early rather than suffering in silence. They also called on students to avoid stigmatizing colleagues facing mental health difficulties.
Students were also cautioned to safeguard their personal belongings, particularly phones and laptops, as they settle into campus life. Officials warned that new students are often targeted by thieves during the first weeks of the academic year.
The opening session for the 2026 orientation concluded with a message of encouragement, with MakCHS leaders expressing confidence that the students would develop into competent, ethical and compassionate healthcare professionals capable of contributing to Uganda’s health sector and beyond.
The Orientation Programme continues until Friday, 7th August, and all students were strongly encouraged to attend every session to give themselves the best possible start to their academic journey. Important topics to be covered include IT services, registration procedures, university policies, mental health and well-being, and awareness and prevention of sexual harassment. These sessions are designed to equip students with the knowledge and support they need to thrive both academically and personally.
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