There are usually three or more ministries in any particular country which claim to have some form of mandate over sanitation:

• Ministry of Water – From an historic perspective water and sanitation have always been together. Where clean water is piped to the house and the dirty water is taken away by a sewer for centralized treatment, it is logical that the same public utility and Ministry are responsible for services provision and regulation. The logic begins to breakdown when on-site latrines are the main means of excreta disposal.

• Ministry of Health – Poor excreta disposal is a major public health concern and the MoH staff are usually at the forefront of disease control programmes. They are also the staff most likely to be blamed for the outbreak of another cholera epidemic. Their role should primarily be one of regulation, hygiene and preventive health education but they tend to be involved with implementation when setting policies or guidelines, yet don’t have the necessary implementation, budget, technical skills or experience.

• Ministry of Local Government – Under government reform and the devolution of power, local governments can have a statutory duty to provide sanitation services. They are certainly closest to the people and in the best position to understand and meet their needs, however they tend to lack the capacity to undertake this role and it is unlikely to be a political issue or in high demand locally, especially when the unserved are the poorest segments of the population with little or no political voice.

• Ministry of Rural Development – Often are charged with development efforts, including infrastructure at household and community level in the rural areas.

Effective co-ordination within a single ministry can be a difficult process; across different ministries it can be impossible. Add to these four ministries, the layers of central, regional, district, and city responsibilities, and the Ministries of the Environment (who are increasingly aware of the pollution which on-site sanitation can cause to ground, coastal and surface water) and the net result is a tangled web of overlapping, uncoordinated, unworkable policies, low budget allocations, low prioritisation and lack of accountability. Progress in such an environment, particularly on a subject with no political importance or little expressed demand, can be a very frustrating process requiring an inspirational and persistent leader.

Within this environment exist the masons and small scale providers who actually build the latrines and provide sanitation services. These small businesses form part of the informal sector and are usually ignored, and can even be considered illegal, in the policy development processes. The important services they provide go unrecognised, unregulated, unsupported, and under-utilised. As one septic tank emptier in Kampala recently complained:

“We give the sewage works over Sh8 million per month and it pays their wages, but they do not treat us well and one man in particularly insults us and says that we are nobodies to them.”