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
Through a European Union (EU) funded initiative, Makerere University and Mulago Hospital are hosting a German oncology reconstruction specialist Professor Dr. Thiha AUNG. AUNG is a surgeon, trainer at the Deggendorf Institute of Technology (THD), and researcher on cancer from the Deggendorf Institute of Technology (DIT), Germany.
With his international expertise in oncology and medical management roles at his home institution, his visit is a valuable addition to Uganda’s capacity building efforts in medical advancement.
Prof. Aung who arrived in Uganda in late September 2026 and has since then conducted free identified patient specialised surgeries and training for locals. These are expected to span two weeks. For the period, his service intersects medical expertise and humanitarian efforts.
This is not Prof. Aung’s first time in the country; his first major visit was in 2023, when he performed life-changing free surgeries on early patients. He then made medical history in June 2024 when he arrived to perform Africa’s first-ever lymph node transplant at Mulago Hospital.
It was against this background that the Makerere Public Relations Office engaged him in an exclusive interview to share his philosophy on medical service, his experiences in oncology reconstruction, and his unwavering belief that passion and dedication rather than just resources are the true drivers of sustainable medical progress.
Transforming Lives Through Oncology Reconstruction
At the heart of his mission through the ERASMUS – Oncology/Lymphedema project, is the treatment of lymphedema, a condition often referred to as elephantiasis.
In Europe, such surgeries can cost between 80,000 and 100,000 euros, making them inaccessible to many.
Thankfully, Professor and his team, including some of his post graduate students like Anna Friedrich (B.Sc) and Sophia Waser (B.Sc., PA) from the Institute of Medical Science and Engineering, have once again brought this specialised care to Uganda pro bono.
He highlights the story of a teacher who, after receiving surgery, regained her quality of life and returned to the classroom. For him, the impact is exponential. “You change one life, but this person changes a lot in the community.”
This shift from individual surgery to the long-term wellbeing of the community, reinforces the local impact of these services.
Professor AUNG’s Personal Conviction
The professor confessed that inherently, he commands himself that beyond knowledge, true progress is driven by passion and will rather than resources.
He does not agree with those that think money and resources are the sole prerequisite for change in the medical world, stating, “you cannot change with money only.” Rather, he upholds the importance of personal decision and commitment.
When discussing the challenges of working in resource-limited settings, he maintains a simple, direct explanation “it’s always beyond the money.”
Ultimately, the Professor believes that if he can provide the spark, his students and patients can carry through with the same flame for significant change.
Motivation to Serve in Uganda
When asked about his inspiration for entering the field and now volunteering to work in Uganda, he explained that his primary goal was always to serve others. “That’s why I finished my medical school to help as many people as possible with my skills.”
He views his medical expertise not as a tool for the privileged, but as a universal resource., “People are all the same, their anatomy is the same. So, I can help all these people pretty well,” Prof AUNG remarked.
His approach is motivated by a pay it forward dogma where treating a single patient creates a broader societal benefit. He illustrates this through his work with patients who, after surgery, are able to return to their professions like the teacher earlier mentioned.
Tips for Medical Professionals working in Uganda
As a foundation for professional growth, the Professor advised medical professionals working in Uganda to prioritise genuine interest in their work because he believes it is “the most important…” for “if you are interested, you will go far in the profession.”
He further reinforced the human capacity point, noting, “no matter what kind of equipment you have… it all depends on the people operating them and the patient.”
Professor AUNG concluded by encouraging doctors to overcome resource fears through action, stating, “If you want to create impact or change, you do.”
Dr. AUNG is part of the Lymphoedema Warriors Association (LWAU) in Uganda. He describes it as a grassroots organisation and commends them for “leveling the grond”. He reiterated his commitment to work with the organisation in reviewing patient reports to determine the best course of treatment.
Makerere University’s School of Public Health (MakSPH) showcased research, training and international partnerships supported through European Union funding during the EU Uganda Research and Study Fair 2026 held at Makerere University.
The fair brought together students, researchers, academics, government representatives and development partners to explore opportunities in education, research, innovation and international collaboration, while celebrating 50 years of partnership between Uganda and the European Union.
Through its exhibition, MakSPH highlighted research and capacity building initiatives addressing public health challenges including infectious diseases, non communicable diseases, health systems, climate change and pandemic preparedness.
18 EU funded projects supported at MakSPH
Prof. Rhoda Wanyenze, Dean of Students, School of Public Health, said the School has benefited from 18 EU funded projects over the past five years, supporting research and training across several areas of public health.
She said the projects have contributed to the training of PhD researchers and the development of research addressing infectious diseases and prevention, non communicable diseases, health systems, climate change and health.
Prof. Wanyenze also highlighted a new five year programme which started in 2021 that is aiming at strengthening capacity for research on pandemic preparedness and response, including outbreaks such as Ebola.
Another programme being undertaken with the Ministry of Health and Karolinska Institute focuses on improving maternal health while also addressing adolescent pregnancy and the health of mothers and children.
She described partnerships as critical to advancing science and innovation, noting that collaboration allows researchers in Africa and Europe to share knowledge and strengthen the impact of research on communities.
Research partnerships strengthen innovation
Prof. Robert Wamala, Director of the Directorate of Research, Innovation and Partnerships at Makerere University, said the exhibition provided an opportunity to showcase EU funded projects across the University.
He noted that the School of Public Health alone has more than 18 such projects, while other colleges also have several EU supported initiatives.
One of the projects showcased was PREPARE TID, a partnership aimed at developing rapid diagnostic technologies for emerging and re emerging infectious diseases.
Prof. Julius Okuni, Associate Professor of Veterinary Pathobiology and Molecular Diagnostics at Makerere University, said the project brings together universities, industries and other organisations from Africa and Europe.
The project is working to develop technologies that can quickly identify pathogens responsible for outbreaks such as Ebola, Rift Valley fever and Crimean Congo haemorrhagic fever.
According to Prof. Okuni, Makerere is involved in field and laboratory work to test and refine the technologies before they can be delivered to end users.
Fair provides platform for research visibility
For researchers at MakSPH, the fair also provided an opportunity to increase the visibility of ongoing research and create new connections with researchers, policymakers and potential funders.
Dr. Raymond Tweheyo, Honorary Lecturer and Senior Research Fellow in the Department of Health Policy, Planning and Management, said such exhibitions allow researchers to share their work and identify others working on related challenges.
He cited the CONNECT for Health project, which focuses on transforming non-communicable disease care in Uganda through collaboration with partners across several countries.
Dr. Tweheyo said exhibitions can help researchers connect with policymakers, civil society organisations and other partners who can contribute to translating research into practical solutions.
Assoc. Prof. Angelina Kakooza Mwesigye, Associate Professor and Child Neurologist at Makerere University College of Health Sciences, also emphasised the importance of exposing young people to international research opportunities.
She said the long standing Uganda Europe partnership provides opportunities for the next generation of researchers to learn, build networks and prepare for future research collaborations.
The School of Public Health’s participation highlighted the role of international partnerships in strengthening research capacity, supporting innovation and developing evidence based responses to Uganda’s public health challenges.
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