Access to improved sanitation is a key preventive measure against sanitary-related gastro-enteric diseases such as diarrhoea. We assessed the access to sanitation facilities and users' satisfaction in 50 randomly selected slums of Kampala through a cross-sectional survey conducted in 2010. A total of 1500 household respondents were interviewed. Sixty-eight per cent of the respondents used shared toilets, 20% private, 11% public toilets and less than 1% reported using flying toilets or practising open defecation. More than half of the respondents (51.7%) were not satisfied with their sanitation facilities. Determinants for satisfaction with the facilities used included the nature and type of toilet facilities used, their cleanliness, and the number of families sharing them. The study findings showed that slum dwellers had high access to sanitation facilities. However, most of them were shared and majority of the respondents were not satisfied with their facilities, primarily due to cleanliness and over demand.

Dirty shared toilets are a health risk to users in urban slum settlements. For health and non-health benefits among users of shared toilets to be guaranteed, their cleanliness is important. The objective of this study was to investigate the cleanliness situation of shared toilets in Kampala’s slums and the psychological and social dilemma factors influencing users’ cleaning behaviour and commitment by using the risks, attitudes, norms, ability and self-regulation (RANAS) model and factors derived from the social dilemma theory.

Shared sanitation is not currently accepted within the international normative definitions of “basic” or “safely managed” sanitation. We argue that pro-poor government strategies and investment plans must include high-quality shared sanitation as an intermediate step in some densely populated urban areas. User experience must be considered in establishing the definition of high quality. We call for additional research on effective interventions to reach these quality standards and for the development of rigorous measures applicable to global monitoring.