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A review of potable water accessibility and sustainability issues in developing

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Shedrack R. Nayebare*, Lloyd R. Wilson, David O. Carpenter, David M. Dziewulski and
Kurunthachalam Kannan
A review of potable water accessibility and
sustainability issues in developing countries –
case study of Uganda
Abstract: Providing sources of sustainable and quality
potable water in Uganda is a significant public health
issue. This project aimed at identifying and prioritizing
possible actions on how sustainable high quality potable
water in Uganda’s water supply systems could be achieved.
In that respect, a review of both the current water supply
systems and government programs on drinking water in
Uganda was completed. Aspects of quantity, quality, treat-
ment methods, infrastructure, storage and distribution
of water for different water systems were evaluated and
compared with the existing water supply systems in the
U.S., Latin America and the Caribbean, for purposes of
generating feasible recommendations and opportunities
for improvement. Uganda utilizes surface water, ground-
water, and rainwater sources for consumption. Surface
water covers 15.4% of the land area and serves both urban
and rural populations. Lake Victoria contributes about
85% of the total fresh surface water. Potable water qual-
ity is negatively affected by the following factors: disposal
of sewage and industrial effluents, agricultural pesticides
and fertilizers, and surface run-offs during heavy rains.
The total renewable groundwater resources in Uganda
are estimated to be 29 million m3/year with about 20,000
boreholes, 3000 shallow-wells and 200,000 springs, serv-
ing more than 80% of the rural and slum communities.
Mean annual rainfall in Uganda ranges from 500  mm to
*Corresponding author: Shedrack R. Nayebare, Department of
Environmental Health Sciences, School of Public Health, University
at Albany, SUNY, Albany, NY 12201, USA,
E-mail: shedracksons@yahoo.com; snayebare@albany.edu
Lloyd R. Wilson and David M. Dziewulski: Department of
Environmental Health Sciences, School of Public Health, University
at Albany, SUNY, Albany, NY, USA; and Bureau of Water Supply and
Protection, New York State Department of Health (NYSDOH), Albany,
NY, USA
David O. Carpenter: Institute for the Health and the Environment,
University at Albany, Rensselaer, NY, USA
Kurunthachalam Kannan: Department of Environmental Health
Sciences, School of Public Health, University at Albany, SUNY,
Albany, NY, USA; and Wadsworth Center, New York State Department
of Health, Albany, NY, USA
Rev Environ Health 2014; aop
2500 mm. Groundwater and rainwater quality is mainly
affected by poor sanitation and unhygienic practices.
There are significant regional variations in the accessi-
bility of potable water, with the Northeastern region hav-
ing the least amount of potable water from all sources.
Uganda still lags behind in potable water resource devel-
opment. Priorities should be placed mainly on measures
available for improvement of groundwater and rainwater
resource utilization, protection of watersheds, health edu-
cation, improved water treatment methods and distribu-
tion in rural areas, and pollution control and monitoring.
Implementing these changes can promote potable water
accessibility especially to the poor populations living in
rural and urban slum areas because they comprise the
majority (80%) of Uganda’s population.
Keywords: government legislations; potable water; water
disinfection; water distribution; water pollution; water
systems (surface water, groundwater and rainwater).
DOI 10.1515/reveh-2013-0019
Received December 3, 2013; accepted April 23, 2014
Background and Introduction
Despite numerous surface and groundwater sources in the
country, Uganda’s population still faces intermittent short-
ages in potable water supply, and most of those that have
a continuous supply are served water originating from
eutrophic surface water sources. To date, the goals related
to water supply have been to improve the accessibility and
continuity of the supply and to deal with the acute health
concerns pertaining to water quality issues (i.e., micro-
bial contamination, color, turbidity, and chemical con-
taminants). As the water supply develops and improves
to mitigate acute issues like biological contamination,
more emphasis may be placed on the chronic health con-
cerns associated with contaminants like the disinfection
2      Nayebare et al.: Potable water issues in developing countries

by-products (DBPs). In this review, we aimed at identify-

ing the gaps in Uganda’s water supplies and suggest some
feasible recommendations for improvement.
We evaluated different water supply systems (i.e.,
surface water, groundwater, and rainwater) as well as
the drinking water legislation, so as to clearly define the
current state of Uganda’s water supply. Our review covers
the aspects of quantity, quality, treatment methods, infra-
structure, storage, and distribution of water for the differ-
ent water systems in Uganda. This review also attempts
to compare these with water supply systems and regula-
tions in the U.S., Latin America, and the Caribbean coun-
tries. Details of our reviews on water supply systems and
legislation for the U.S., Latin America and the Caribbean
countries can be found online at http://gradworks.umi.
com/15/12/1512996.html.
On the one hand, the U.S. was considered for compar-
ison due to the extensive current research in water devel-
opment conducted in the country and the efficient water
supply programs and laws/legislation that could be used
to suggest improvements in Uganda. On the other hand,
Latin American and Caribbean countries have relatively
similar settings as Uganda in terms of potable water acces-
sibility, as defined by several criteria like water resource
distribution, water pollution issues, and public awareness Figure 1 Map of Uganda Showing Major Lakes, Rivers and Regions
challenges related to sanitation and hygiene (1). Thus, it of the Country (2).
would be suitable to recommend practices appropriate
for Uganda, which have been effectively implemented in
these countries. Furthermore, in an effort to devise more Corporation (NWSC) (5), which essentially obtains its raw
feasible recommendations on future water development water from lakes. Urban supply of domestic water is deliv-
plans that are applicable to Uganda and other develop- ered through piped household water connections and
ing countries, an analysis of the cost-benefit and obsta- communal tap-stands using an approved fee schedule of
cles present to implementation of the activities aimed at the Ministry of Water and Environment (MWE).
improving water supplies in Uganda was completed. Those living in rural and suburban communities com-
prise about 80% of Uganda’s population. The NWSC does
not extend to these communities, so the surface water is
Surface water mainly obtained from rivers, streams, swamps, seepages,
ponds, and sometimes floods during rainy seasons. Some
Accessibility issues of the surface water in rural areas comes from unprotected
springs that form stagnant ponds. With the exception of
Despite the existence of a vast number of lakes (about 27 in communities living on lake shores, many surface water
total), rivers and streams (Figure 1), Uganda continues to sources in rural areas are seasonal, and thus, are mostly
face the issue of limited accessibility to potable water, par- available and utilized during the rainy seasons.
ticularly in rural and poor urban communities. Uganda’s
surface water sources cover 15.4% of the total land area
(236,040 km2) and these provide domestic water supply to Quality issues
both urban and rural populations (3). The current popula-
tion of Uganda stands at 34.76 million people, of which Water pollution ensuing mostly from anthropogenic activi-
about 20% reside in urban areas (4). It is estimated that ties (e.g., agriculture, industrialization, and sewage dis-
about 71% of the urban population have access to potable charge) remains a significant impediment to potable water
water distributed by the National Water and Sewerage supply in Uganda. In fact, most fresh surface water sources
 Nayebare et al.: Potable water issues in developing countries      3

rate poorly in terms of bacteriological and chemical quality.
In rural and slum communities, the major issues with
potable water are mostly related to poor bacteriological
quality. Such poor quality is due to unhygienic practices
characterized by widespread use of poorly constructed and
sited pit latrines/toilets and dilapidated sewage systems,
as well as the complete lack of sanitary facilities where
open defecation in the fields is practiced in Uganda (6)
and other neighboring countries (7). The majority of the
people in these communities are living under the poverty
line (earning just about 1US$ per day), which significantly
impedes the execution of activities aimed at improving
potable water supplies due to sustainability issues.
Case study on Lake Victoria
With a surface area of 68,800 km2 (mean and maximum
depths of 40 m and 79 m, respectively) and a total catch-
ment area of 195,000 km2 (8), Lake Victoria (L. Victoria)
is the second largest freshwater lake in the world and
contributes about 85% of the total fresh surface water in
Uganda. The lake is a shared resource among the coun-
tries of Uganda, Tanzania, and Kenya in proportions of
45%, 49% and 6% of the surface area, respectively (3, 8).
It is a vital source of water supply for both domestic and
industrial purposes in the East African region and sup-
ports the livelihood of millions of people (8). The NWSC
draws its raw water from this lake and uses it to serve more
than 10 million people living in over 25 districts within the
lake basin area (4). This lake is eutrophic due to excessive
inflows of nutrients (mainly phosphorous and nitrogen),
which has promoted the growth of the common water hya-
cinth (Eichhornia crassipes) and algae (9). Since the 1960s,
there has been a five-fold increase in algal growth on the
lake (10, 11) and as a result, the water appears green with
high levels of total organic carbon (TOC) and poor micro-
bial quality (12). Water pollution on the lake is essentially
due to the discharge of raw and partially treated sewage
and dumping of domestic and industrial chemicals as well
as organic waste and fertilizers from several agricultural
farms in the lake basin. There are several medium-to-large
scale industries and numerous small-scale enterprises
located on the L. Victoria catchment area; these discharge
high organic, nutrient-rich effluents loaded with metals
and organic pollutants into the lake (13) without any prior
onsite pre-treatment.
In addition, the Lake contains inhabited islands (3000
Ssese Islands), and native fishing populations dump their
excreta directly into the water. Kampala City, the capital
of Uganda, is located within the catchment area of L.
Victoria. Most of the wetlands around the lake have been
cleared for farming and human settlement, while the
industrial discharges and storm water containing urban
run-off from this city flows untreated into the Nakivubo
channel, which drains directly into L. Victoria’s Inner
Murchison Bay (14). At the Nakivubo channel discharge
point into the lake, biochemical oxygen demand (BOD)
is > 3.5 milligrams per liter (mg L–1), which indicates sig-
nificant organic loading. Meanwhile, phosphorus levels
range from 1.0 to 4.0 mg L–1 (15), representing values that
are significantly greater than the World Health Organiza-
tion (WHO) recommended maximum tolerance level of
0.1 mg L–1 for surface water. This has been closely linked
to the occurrence of widespread and severe algal blooms
within the bay (15), intensive color, turbidity levels of up
to 84.0 nephelometric turbidity units (NTUs), and patho-
genic microorganisms occurring in the Lake (16). General
water quality parameters in Lake Victoria are summarized
in Table 1.

Table 1 Summary of some of the water quality parameters in L. Victoria.

Parameter   Recorded levels  References

Turbidity   Up to 84.0 NTU  Balirwa et al. (16)

Biological oxygen demand (BOD5)  61–475 mg L–1  Oguttu et al. (17)
Chemical oxygen demand (COD)   506–3877 mg L–1  Oguttu et al. (17)
Phosphorous (P)   2.4 mg L–1  Awange and Obiero (18)
  5.0 mg L–1  Oguttu et al. (17)
  4.0 mg L–1  Oyoo (15)
  0.94–7.0 mg L–1  Madadi et al. (19)
pH   7.0–9.9  Oguttu et al. (17)
Nitrogen (N)   4.8–10.8 mg L–1 as NO3–  Oguttu et al. (17)
2.6–10.8 mg L–1 as NH4+
Lead (Pb)   0.02–0.05 mg L–1  Oguttu et al. (17)
Manganese (Mn)   0.02–0.91 mg L–1  Oguttu et al. (17)
4      Nayebare et al.: Potable water issues in developing countries
Surface water treatment
As outlined below, modern surface water treatment
methods are employed by the NWSC in the treatment of
water distributed in urban areas. The NWSC has three
water treatment plants (Gaba I, II, and III) supplying
treated water to Kampala City and the surrounding areas.
In addition, the NWSC operates at least one water treat-
ment plant for every major town across the country, from
which the residents are supplied treated water. In rural
areas and slum communities, water treatment, if any, is
mainly done by boiling at household level, and to a small
extent, by performing household-based water filtration
with the use of chlorine tablets and solar disinfection
(SODIS), as discussed in the groundwater section.
Filtration
The National Water and Sewerage Corporation (NWSC)
usually performs water filtration in three stages – the first
two stages screen using trash racks and inlet screens, and
the third stage is rapid gravity filtration using fine sand. The
complete filtration process involves screening, coagulation,
flocculation, sedimentation, and rapid gravity filtration.
Screening
A set of mechanical screens (trash racks, 3 inches wide)
and a second set with smaller openings are installed at the
inlet point into the drinking water treatment plant. This
is meant to screen out large organic and un-decomposed
materials like wood, plastic, and dead fish. This reduces
water turbidity and ultimately prevents coarse materials
from entering the remainder of the treatment process.
Coagulation
This step involves the destabilization of suspended parti-
cles by surface charge neutralization to promote agglom-
eration into larger particles for easy removal (20, 21).
Water is dosed with alum [Al2(SO4)3] at a relatively low
concentration of ∼5 mg per liter (mg L–1) (22, 23) to facili-
tate agglomeration (24), while constantly monitoring pH
for efficient solubilization of aluminum species. Optimum
sweep coagulation occurs when negatively-charged forms
of alum predominate, which occurs at pH 6–8 (20, 21).
Flocculation
The agglomeration of small suspended particles into larger
particles for easy removal follows the coagulation step
(20). The water flows into a flocculation chamber where
it is retained for 10–30 min to allow complete agglomera-
tion into larger particles that can easily settle out of the
water (20, 24). Several factors determine the efficiency of
coagulation and flocculation processes, including type
and dosage of coagulant, pH, flocculator retention time,
water flow, intensity, and duration of mixing.
Sedimentation
Efficient flocculation leads to sedimentation where sus-
pended particles settle out of the water and come to rest at
the bottom. The NWSC uses gravitational settling during
water treatment. Here, the water passes through a clari-
fier with little disturbance, where the macro-flocs settle to
multiple parallel plates (lamellar settler) or to the bottom
of a vessel and clear water flows out over an effluent
baffle into the rapid-gravity sand filtration bed. The solids
collected at the bottom are then removed by a mechani-
cal “sludge collection” device and pumped into sludge
drying beds. Clarifiers are usually shallow at the inlets but
become deeper towards the outlets so as to ensure quies-
cent conditions that promote settling.
Rapid gravity filtration
The water exiting the clarifier is allowed to trickle through
a fine sand filter bed. This helps to further strain out
any suspended particles and some microorganisms that
would have survived the initial processes before the water
is chlorinated. The filter bed is cleaned/ maintained by
backwashing and periodic scrapping off of the clogged
upper layer of sand and replacing it with clean sand. The
frequency of cleaning depends mainly on the frequency of
use, but is usually done every 72 h of constant operation.
Disinfection
Public water supplies primarily use chlorination. The
disinfection methods applied for surface water in rural
Uganda differ from those used in urban areas. The urban
populations mainly utilize water supplied by the NWSC,
which is chlorinated prior to distribution. Water is treated
so that a free chlorine residual of 0.5 mg L–1 is maintained
throughout the distribution. However, for the most part
this is never attained in practice. Treated water is moni-
tored for: pH 6.7–7.2; true-color less than ( < ) 15 Platinum-
Cobalt Color (Pt-Co) units; turbidity < 5 NTU; NH4+ < 1.5 mg
L–1; NO3– < 50 mg L–1; SO42– < 250 mg L–1; and total coliforms
–0 counts/100 mL (25).
 Nayebare et al.: Potable water issues in developing countries      5
Storage
There are no organized water storage facilities for most
households in rural and slum communities. Water is
drawn from the source in relatively small containers of
about 5–20 liters (L) and is stored and used therein. A few
households will occasionally have water storage tanks
with a capacity of more than 100 L. In order to keep these
filled, school-aged children spend much of their time
fetching water and missing school. The distances walked
to the water sources can often be up to several kilometers
(km) (26). Urban households with a connection to piped-
water by the NWSC usually have water storage tanks
installed, but the capacity of these tanks varies depend-
ing on the affordability. The capacity usually ranges from
a few hundred liters to thousands of liters. The water treat-
ment plants also have water storage tanks corresponding
to the daily output of the treatment plant and these help to
ensure a steady supply of water just in case of an interrup-
tion in water production. For instance, the NWSC Gaba III
water treatment plant produces about 85,000 m3 of treated
water daily, and there are water storage tanks which can
store in excess of this amount of water in five different
locations in Kampala City (27).
Distribution
There are significant regional disparities in distribution
of surface water sources in Uganda. Most of the lakes
and rivers are located in the Central, Southern, Eastern,
and Western regions of the country. In the Northern and
Northeastern regions, the available rivers are mainly sea-
sonal and will flow only during heavy rains. Utilization of
surface water in these regions is not widespread as it is not
available for most part of the year. Thus, people mainly
depend on groundwater from deep wells (at least 30  m
deep). Water accessibility in these regions, especially the
Northeastern, is a huge issue compared with any other
part of the country.
Groundwater
Accessibility issues
The total renewable groundwater resources in Uganda
is estimated at 7.661 billion gallons/year (or 29.0 million
m3/year) (28) with an estimated 20,000 deep-wells, 3000
shallow-wells, 12,000 protected springs (29) and over
200,000 springs (30) in rural communities. Deep-wells
and springs are the most important potable water sources
for the people in rural communities, especially in Eastern
and Northern regions where they provide over 80% of
domestic water supply (31). Slight improvements in urban
groundwater accessibility have been realized since the
early 1990s (32).
Quality issues
Bacterial contamination from poor sanitation facilities is
the foremost issue facing groundwater quality in Uganda
(33, 34). Fecal coliforms and high nitrate (NO3–) concen-
trations have been detected in water from most springs in
slum areas (35). Coliform counts in water from shallow-
wells are much higher (36) due to localized pollution (30)
from numerous poorly sited pit latrines, poor drainage,
and waste management systems as evidenced in most
slums in East Africa (37–39) and indeed other develop-
ing countries. In Kampala City, only 55% of the popula-
tion has access to piped water, out of which only 9% is
connected to the sewage system, implying that the rest
use pit latrines that pollute groundwater in such areas. A
pilot study on quality of water from protected springs in
Kampala indicated that 90% of the springs had total coli-
form counts that did not meet the World Health Organiza-
tion (WHO) drinking water guideline of 0 counts/100 mL
(25, 35). Nitrate (NO3–) concentrations in Uganda’s ground-
water vary from one place to another, but can be chal-
lenging in some areas where high NO3– concentrations of
up to 26 mg L–1 as nitrogen have been detected since the
early 1990s (40) and most of this contamination is mainly
linked to poor sanitation practices. Agricultural applica-
tion of NO3– is not widespread in Uganda.
In communities where deep-wells (at least 30  m
deep) are used, microbial and nitrate contamination
of water sources is usually limited (30), and if properly
maintained, the quality of groundwater from deep-wells
is good enough even without any disinfection. Chemi-
cal contamination of groundwater in rural Uganda is
low. Fluoride from volcanic soils and rocks seems to be
the most serious inorganic contaminant in groundwater.
The crater lakes of Western Uganda and the neighboring
groundwater sources have often been found to have fluo-
ride concentrations exceeding 4.5 mg L–1 (31, 41). Fluoride
concentrations exceeding the WHO guideline of 1.5 mg L–1
have been measured in groundwater from Rift Valley and
Rwenzori mountains of Western Uganda, the volcanic
areas of the Eastern Uganda (Sukulu Hills and Elgon areas
in Mbale), and the Northeast (Moroto areas) where the
incidence of fluorosis is usually high (42). Despite several
6      Nayebare et al.: Potable water issues in developing countries
water-quality issues, groundwater remains a vital and
feasible potable water source in rural Uganda because it
requires less treatment. The operational costs of ground-
water systems are significantly less than those of surface
water systems and thus are more likely to be sustainable
in rural and slum communities.
Groundwater treatment processes
and storage
Filtration
Filtration of groundwater is not a widespread practice in
Uganda. Water from deep-wells is usually clear with no
color and turbidity. Thus, it is a common practice to use
this water without any prior filtration or other treatment.
Disinfection
Groundwater use has not yet been applied on a commer-
cial scale and thus, unlike surface water, the disinfection
processes are mainly home-based, with a few exceptions
where water disinfection is done at the water source
mainly during epidemic outbreaks of waterborne diseases
like cholera and hepatitis E. Water treatment methods cur-
rently used at household level are discussed below.
The most common method of water disinfection used
at household level is boiling. Water is boiled at 100°C
(212°F) for at least 1 min and allowed to cool under hygienic
conditions. This can kill most of the pathogens in water.
However, the water can readily get re-contaminated if not
handled properly because boiling does not provide any
long-term protection (e.g., chlorine residual). Chlorination
is also applied in home-based water disinfection in the
form of calcium hypochlorite tablets or sodium hypochlo-
rite solutions–under the trade name “Water Guard” (1–2
tablets are added per liter of water and allowed to react for
about 30 min before use). This method of water disinfec-
tion has been frequently used during outbreaks of several
waterborne disease epidemics (e.g., cholera, hepatitis E,
etc.) in several parts of Uganda especially in the Eastern
and Northern regions, as well as among the poor urban
residents living in slums.
SODIS is another method used for water disinfec-
tion though it is not as popular as the other methods. The
method combines the use of ultraviolet (UV) light and heat
from the natural sunlight to disinfect the water. Water is
placed in small UV-transparent polyethylene terephtha-
late (PET) or glass bottles of volumes ranging from 0.3 to 2
L that are then filled to three-quarters (¾) of their capacity
and vigorously shaken to increase the dissolved oxygen.
The bottles are then exposed to sunlight for a period of
about 6 h (43, 44).
With the exception of the highly thermo-tolerant and
UV resistant protozoan cysts like Cryptosporidium or Acan-
thamoeba, most pathogens of fecal origin are thought to be
killed if exposed to the heat and UV radiation in sunlight
for a significant period of time (45, 46). However, there are
many efficiency concerns with this technique as several
studies have shown conflicting results. In a study by Mäu-
sezahl et al. (47), SODIS did not reduce childhood diarrhea
in rural Bolivia, and in another study by Preez et al. (48) in
Kenya, the children consuming exclusively SODIS-treated
drinking water were found to be less affected by diarrhea
and physically more developed than the control group.
This method would probably be more applicable, espe-
cially in Uganda due to a favorable tropical climate with
abundant sunlight. However, more community education
on the application of the method as well as research on the
efficiency of the method is needed. Differences in the out-
comes of studies on the application of SODIS for control
of waterborne diarrheal diseases are thought to originate
from improper application of the method.
Storage of groundwater
Groundwater is mainly utilized in rural and slum com-
munities where there is no infrastructure or systems for
organized water storage facilities. Water is stored in con-
tainers (approximate capacity of 5–20 L) that are used for
collection from the source. Inadequate water storage facil-
ities, coupled with distant (as far as 4 km from residences)
and poor/low yield water sources in most rural communi-
ties, are major causes of long queues at the water points
and the consequential loss of valuable time for the school
going children, since they are the ones who fetch water for
their families (26).
Distribution of groundwater in Uganda
Utilization of groundwater for public water supplies is not
well developed in urban Uganda. Only a small portion of
urban dwellers, especially those in slum areas, who cannot
afford piped water from the NWSC distribution system,
utilize groundwater from springs and shallow wells. The
projected Uganda’s groundwater resource utilization for

2030 Groundwater sustainable resource utilization
for domestic water supply
N N
Recharge
Use (%)
(mm/yr)
<5
<12.5
5–10
12.5–25
10–15
25–37.5
15–20
20–25 37.5–50
50–62.5
25–30
>30
Figure 2 Regional distribution of groundwater & its domestic utilization in Uganda (34).
domestic water supply by year 2030 is shown in Figure 2.
For some areas/regions of the country, it is projected that
only 5% of the total groundwater resource will be utilized
by 2030. There are more than 200,000 springs in Uganda
and these serve as important water resources especially in
the mountainous areas, and in the Central, Western, and
Southwestern regions of the country (30) serving the rural
and slum communities. In other areas like Northern and
Eastern regions, deep-wells are the most common water
sources. There are significant regional variations in the
availability of groundwater, with some regions having very
little water throughout the year. In such areas (e.g., North-
eastern and some Eastern parts of the country), ground-
water aquifers (wells) are low yielding with a limited areal
extent and poor recharge rates (49), resulting in major
water shortages for majority of the year.
Only about 15% of the Uganda’s groundwater
resources are utilized currently, and there is still enough
groundwater in most parts of the country to meet future
water demands (34). However, with the current popula-
tion growth rate of 3.5% in Uganda (50), which is accom-
panied by increased encroachment on water catchment
areas mainly for settlement and agriculture, there is likely
to be significant shortages in groundwater resources if
proactive planning is not initiated soon.
Rainwater
Accessibility issues
Rain is a valuable source of potable water in countries that
receive adequate amounts of rainfall (51). Uganda receives
Nayebare et al.: Potable water issues in developing countries      7
Sustainable available groundwater
annual rainfall ranging from 500 mm in the Northeastern
region to 2500  mm in Southwestern regions and areas
within the L. Victoria basin. Though rainwater harvesting
projects have been implemented in Southwestern Uganda,
mainly in the Kigezi region (52), the Central region of the
country and in a few Districts in Eastern Uganda, utiliza-
tion is still minimal, and is mainly done by institutions
like rural primary schools and churches. Effective technol-
ogies to harvest and store rainwater along with incentives
to administer such technologies are needed.
Quality issues
Rainwater quality tends to deteriorate during collection,
storage, and use. Several case-control studies have linked
gastroenteritis and consumption of untreated rainwater (51).
The most commonly used collection surfaces are building
roofs made of corrugated iron sheets. The rainwater storage
tanks are normally made of plastic or cement and sand rein-
forced with iron mesh. The collection surfaces and storage
tanks are usually the potential sources of contamination
since environmental contaminants can adsorb to those sur-
faces. Household hygiene and sanitation can be another
source of contamination during storage and use. Thus,
having properly designed and clean collection systems,
proper water treatment, and good household hygiene prac-
tices can help to preserve rainwater quality (25).
Generally rainwater has less microbial contamination
than surface water. However, within the first 5–10 min of a
rainfall, collected water usually will have higher contamina-
tion with Escherichia coli and thermo-tolerant coliforms due
to unhygienic collection surfaces. Microbial contamination
8      Nayebare et al.: Potable water issues in developing countries
levels decrease significantly as the rain continues due to the
dilution effect and the collection surfaces being frequently
rinsed with fresh rainwater. Under normal environmental
conditions, rainwater is slightly acidic and has a low con-
centration of dissolved minerals. Therefore, it can dissolve
metals and other impurities from collection surfaces and
storage tanks. This can greatly affect the chemical quality
of rainwater, especially where the collection surfaces and
water storage tanks are not made of the right materials.
Treatment of rainwater
Filtration
The storage tanks are usually fitted with a plastic and some-
times steel-coated filter mesh (53), which screens out most
organic debris that are accumulated on the collection sur-
faces and gets carried along with rainwater. Some collection
systems are designed so that the first 5–10 min flash of rain-
water is not collected; this method of rinsing to waste tremen-
dously reduces the amount of debris reaching the filter. This
filtration method does not remove finer suspended particles
that come from dust accumulated on the collection surfaces.
Disinfection
The methods of rainwater disinfection practiced in Uganda
are similar to those reported for groundwater.
Rainwater storage
Storage tanks mostly made of plastic material (PVC), cor-
rugated iron, and sometimes brick masonry tanks with
a capacity ranging from 15 to 100 m3 are currently being
used in schools, church buildings and communal rain-
water collection establishments to serve these particular
institutions and the neighboring communities (52).
Household rainwater harvesting facilities with a jar
or ferro-cement tanks are used for some communities.
The jar is a low cost tank with a capacity of 420 L, which
typically serves a household of about six people on a daily
basis. The ferro-cement tank has a capacity of 4000 L and
a higher initial cost, but provides a better solution for rain-
water storage than the jar.
Distribution of rainwater in Uganda
There are significant regional and seasonal variations in
rainfall with some areas like the Northeastern regions
receiving as low as 500 mm of rainfall annually and other
areas (Central region and L. Victoria basin) receiving as
high as 2500 mm annually. Rainwater systems have only
been used in regions receiving a fair amount of rainfall
throughout the year (e.g., Central, Western, Southwest-
ern, and Eastern regions). The rainy seasons are normally
March to May and October to November, but these periods
have been changing over the past years presumably due to
global climatic change.
Government regulations on water supply in
Uganda
The Ministry of Water and Environment (MWE) regulates
and coordinates the water sector, and is the lead agency
that formulates national water and sanitation policy.
The Directorate of Water Development (DWD) under
the MWE acts as the executive arm; provides support to
local governments and other service providers (54), and
is also expected to monitor the quality of drinking water
provided by the NWSC. However, in practice, the NWSC
monitors its drinking water quality internally without any
complementary external monitoring (55). The NWSC’s
internal Quality Control Department examines whether
the supplied water complies with the national standards
for drinking water, which in turn, follow the WHO drink-
ing water guidelines (27). Figure 3 shows a summary of the
interactions between the different key players in Uganda’s
water supply.
Most of the activities in Uganda’s water sector are said
to be in line with the WHO guidelines but in practice, only
a few water quality parameters are monitored as shown in
Table 2, due to limitations in infrastructure and resources
(like laboratory space and equipment). The operations of
the NWSC are regulated through a performance contract
with the national government. The MWE’s Performance
Review Committee (PRC) reviews the performance of the
NWSC according to this contract. However, the PRC is
partly financed by the NWSC, which hinders its full inde-
pendence (56).
There are laws, regulations, and policies relevant to
the management and utilization of water resources in
Uganda. These laws govern the use of lake resources and
other water catchment areas. They define the rights and
duties of all stakeholders involved in the management of
water resources, as well as outline the fundamental prin-
ciples of action to be followed in developing the rules of
practice in the water sector. The subsections below sum-
marize the legal, policy, and institutional frameworks for
Uganda’s water and sanitation sector.
 Nayebare et al.: Potable water issues in developing countries      9

National Government
(Uganda)
Directorate of Water
Ministry of Water &
Development (DWD)
Environment (MWE)
Water tariffs

National Water and Sewerage

Corporation (NWSC)

Institutional Framework
Legal Context Policy Context Sector-Wide Approach to Planning, 2002
Constitution of the Republic of Poverty Eradication Action Plan (PEAP) a. WRM sub-sector
Uganda, 1995 The National Water Policy, 1999 b. RWSS sub-sector
Water Statute, 1995 The National Health Policy, 1999 c. UWSS sub-sector
Local Governments Act, 1997 The Environmental Health Policy, 2005 d. WFP sub-sector.
Institutional Roles and Duties
National Environment Statute, 1995 The National Gender Policy, 1999
a. District Roles and Duties; DWO,
Public Health Act, 1964
WUGs, DDHS, DDCBS, DEO, CAO,
Land Act, 1998 District Planner

Figure 3 Summary of the interactions between the Legal, Policy and Institutional frameworks and the different key Stakeholders in
Uganda’s water Sector.

Table 2 Comparison of the WHO, U.S. EPA, and Uganda’s National Standards/Guidelines for Drinking Water Quality.

Parameters   WHO 1998 Guidelines of   National Drinking Water   Uganda, 1994 National
Drinking Water Quality Regulations in USA (U.S. EPA) Drinking Water Standards

Color   15 Pt-Co units   15 Pt-Co units   15 Pt-Co units

Turbidity     ≤  5 NTU     ≤  5 NTU     ≤  5 NTU
Chlorine   –   4 mg L–1 as Cl2   0.5 mg L–1
PH   –   6.5–8.5   6.5–8.5
Fluoride   1.5 mg L–1   4.0 mg L–1   1.0–1.5 mg L–1
Nitrate   50 mg L–1 as NO3–   10 as N2 / 44.44 as NO3–   50 mg L as NO3–
Sulfate   250 mg L–1   250 mg L–1   250 mg L–1
Iron   0.3 mg L–1   0.3 mg L–1   0.3 mg L–1
Ammonia   1.5 mg L–1   –   1.5 mg L–1
Total coliforms   0 counts/100 mL   0 counts/100 mL   0 counts/100 mL

Legal context Sewerage Regulations, 1999) list a number of activities

The Constitution of the Republic of Uganda, 1995:
This provides for the protection and preservation of
water sources and the environment. It also allows for the
measures to promote good water management to prevent
damage to air, land, and water resources resulting from
pollution and any other causes. The standards and poli-
cies for management of water quality include the follow-
ing: National Standards for Drinking Water, 1994; WHO
Guidelines, 1998; National Effluent Standards; and Pro-
visional Water Quality Guidelines, 1996 for rural water
supplies.
The Water Act, 2000 and the accompanying regula-
tions (Water Resources Regulations, 1998; Waste Discharge
Regulations, 1998; Water Supply Regulations, 1999; and
that must be implemented so as to protect, develop and
sustain water sources, as guided by the objectives in the
1995 Constitution of Uganda. This also includes the leg-
islative context for the protection of water sources as well
as water quality testing and monitoring, which in turn, is
guided by the National Water policy (NWP), 1999. At the
implementation level, all the activities that are known to
significantly affect water quality are controlled through a
range of endorsements that are either managed directly by
the Directorate of Water Development (DWD) or in partner-
ship with National Environmental Management Authority
(NEMA). The National Environmental Act, 2000 (chapter
150) and the NWP, 1999 provide the recommendations for
approval of Environmental Impact Assessments (EIAs)
related to the quality of drinking water.
10      Nayebare et al.: Potable water issues in developing countries
The Water Statute, 1995: This is the principal law
for the water sector that incorporates water resources
management and water and sanitation legislation. The
statute provides the agenda for the use, protection, and
management of water resources as well as the constitu-
tion of water and sewage facilities so as to facilitate the
delegated responsibilities for water and sewerage activi-
ties. This statute sets out four main objectives: (1) to
promote a balanced management and use of water, (2) to
promote the supply of sufficient potable water to all citi-
zens, (3) to regulate pollution of water sources, and (4)
to allow for organized advancement and usage of water
resources.
The Local Governments Act, 1997: This Act defines
the roles of different levels of government in the provision
and management of water and sanitation-related activi-
ties. This is done in conformity with the Constitution and
builds on the Decentralization Act of 1995.
The National Environment Statute, 1995: Empow-
ers NEMA, which has a collective duty with DWD to ensure
water quality standards, standards for discharge of all
effluents into water, limits on the uses of water bodies,
management of riverbanks and lake shores, and restric-
tions on the use and management of wetlands.
The Public Health Act, 1964: This sets out the frame-
work for regulating the pollution of the environment (air,
water, etc.) to acceptable levels so as to preserve human
health.
Water Resources Regulations & Wastewater Dis-
charge Regulation, 1998: This prescribes the threshold
and procedure for applications to construct any works,
use water, or discharge waste under the Water Statute
1995. The Water Statute, 1995 provides for the establish-
ment of regulations for controlling water abstraction and
wastewater discharge through the use of permits.
Land Act, 1998: This describes the various land
tenure systems in Uganda like the customary, mailo,
freehold, and leasehold systems. Land tenure issues are
critical to the development of water infrastructure. Any
location of a water supply project must respect the propri-
etary rights of the landowner or occupier.
Policy
The policy trend for water quality management is steered
towards the protection of public health, improved human
resources, ecosystem integrity, and social-economic
development. The overall government policy objectives
for water resources management and utilization related to
drinking water supply are as follows:
a. to ensure full participation of all stakeholders in an
integrated as well as sustainable management and
development of Uganda’s water resources, in order
to secure and provide water of adequate quantity
and quality for all socio and economic needs of the
current and future generations–the National Water
Policy, 1999; and
b. to provide sustainable provision of safe water within
easy reach and hygienic sanitation facilities based on
management obligation and ownership by the users
to 77% and 100% of the rural and urban populations,
respectively, by the year 2015 with an 80%–90% rate
of effective use and functionality of facilities.
The National Water Policy, 1999: This elaborates on
the Water Statute of 1995 and provides the overall policy
context for the water sector. It promotes an integrated
approach for the management of water resources in the
most sustainable and beneficial ways. It accentuates a
continuous acknowledgment of water as a common social
and economic good, whose allocation for domestic use
should be given first priority.
The National Health Policy, 1999: This restates that
sanitation is a mandate of the Ministry of Health (MoH).
The Government places greater emphasis on improving
sanitation and hygiene, especially in the rural and urban
slum areas where access to safe water and sanitation cov-
erage is low.
The Environmental Health Policy, 2005: This estab-
lishes the environmental health priorities (clean/safe
drinking water, housing, clean air, etc.) of the government
and provides a framework for the development of services
and programs at the national and local levels. The goal of
the Policy is the attainment of a clean and healthy living
environment for all citizens in both rural and urban areas.
The National Gender Policy, 1999: This recognizes
women and children as the major carriers and users of
water as well as encourages women to play a major role in
decision making concerning water and sanitation activi-
ties. It establishes the importance of gender responsive-
ness in terms of planning, application, and management
of water and sanitation initiatives. Based on this policy,
the involvement of women in decision-making has been
nationally established and is valued at all levels.
Institutional framework
Sector-wide approach to planning (SWAP), 2002: The
water and sanitation officials use the SWAP to support
its policy and expenditure programs. The rural water and
 Nayebare et al.: Potable water issues in developing countries      11
sanitation sub-sector is the most advanced in terms of its
application of SWAP, and is divided into four sub-sectors
that perform different activities within the sector accord-
ing to the Decentralization Act, 1995 as follows:
a. the Water Resources Management (WRM) sub-sector,
which is concerned with the sustainable management
of water resources so as to deliver adequate and potable
water for the current and prospective generations;
b. the Rural Water Supply and Sanitation (RWSS) sub-
sector, which encompasses the provision and upkeep
of adequate supply of potable water for people living
in rural areas. The sanitation aspect deals with
hygiene and sanitation education plus campaigns in
rural communities and schools;
c. the Urban Water Supply and Sanitation (UWSS)
sub-sector, which includes services for human
consumption, industrial use and other uses in urban
areas (centers with population > 5000 people); and
d. the Water for Production (WFP) sub-sector, which
addresses the issue of water for agricultural production
(irrigation, livestock, fish farming, etc.). The Ministry
of Agriculture, Animal Industry and Fisheries
(MAAIF); and the DWD/MWE are responsible for WFP
Institutional Roles and Duties
There are several institutions/stakeholders involved in the
water sector. The MWE and DWD are responsible for com-
munications among stakeholders. The NWSC provides
water and sewage services in major urban centers, while
the MoH is responsible for formulation and implementa-
tion of policy to promote sanitation and hygiene. Finally,
the Ministry of Education and Sports provides sanitation
and hygiene promotion in primary schools and works to
ensure that all the essential sanitation and hygiene facili-
ties required are available for the pupils. Local governments
are responsible for the provision of rural water services and
management activities with help from the DWD.
District Roles and Duties
The District Water Office (DWO) leads the implementa-
tion of water and sanitation activities at the district level,
and is responsible for initiation and follow-up of capacity
building. It is also responsible for ensuring operation and
maintenance of water and sanitation facilities. The District
Directorate of Health Services (DDHS) ensures coordina-
tion with the DWO in the implementation and promotion of
sanitation and hygiene education. The District Directorate
of Community Based Services (DDCBS) works with the DWO
on matters related to community sensitization and mobi-
lization before and after construction of water and sanita-
tion facilities. The District Education Officer liaises with
the DDHS and the DWO in planning and implementation
of sanitation and hygiene education in schools. The Chief
Administrative Officer (CAO) serves as the accounting officer
and is in charge of the general management and approval
of the district water and sanitation activities. Overall, the
administrative aspect of water sector is complex, and
involves several stakeholders and ministries, which some-
times delays the implementation of development programs.
Recommendations on some potential
opportunities for improving
drinking water supplies in Uganda
Surface water
The poor quality of surface water in Uganda directly affects
the quality of potable water available in the public water
systems. The drinking water treatment methods used
in rural areas are mostly rudimentary, making it almost
impossible for the final treated water to meet the stand-
ard requirements for potable water. Regulations, policies,
and laws on the protection of water resources do exist
but their implementation/or enforcement is inadequate.
Thus, there is a need to strengthen the entire regulatory
process to protect the quality of potable water. Following
are some of the recommended measures that could help
improve the quality of potable water if prioritized.
a. Strengthening the protection of watershed areas –
This can be done through the strict enforcement of
the government legislations, policies, and laws on
preservation and protection of natural water resources
and wetlands.
b. Extensive health education of the local populations
related to proper sanitation and hygiene practices.
c. Use of slow sand filters or modified slow sand filters
(with a layer of activated carbon)-These might be
useful in suburban or more rural areas if; (a) the
water can be transmitted to those areas, and (b) the
materials and skills are available. This would help with
the removal of microorganism and organic materials,
and has the advantage of an active biological layer.
However, microbial disinfection/inactivation would
still be required to ensure completely safe potable
water. Rapid gravity filtration remains appropriate
12      Nayebare et al.: Potable water issues in developing countries
for urban areas serving larger populations with the
resources and infrastructure to maintain the process.
d. Although not discussed in this review, it should be
noted that using Cl2 exclusively to disinfect the water
potentially poses problems related to formation
of carcinogenic DBPs because surface water has
high total organic carbon (TOC) levels. Aside from
the fact that TOC influences the effectiveness of Cl2
disinfection, the attachment of bacteria to surfaces
provides the greatest increase in disinfection
resistance (57), thereby increasing Cl2 demand. The
use of chlorine dioxide [ClO2] in combination with
chlorine gas for disinfection would help enhance
bacteriological quality of water and also prevent the
formation of DBPs in the final treated water.
e. Use of infiltration galleries near the lakes – This allows
the heavily polluted lake waters to undergo natural
soil filtration before it is pumped into the water
treatment plant for additional treatment. This can
help reduce the burden on water treatment plants and
thus improve both the bacteriological and chemical
quality of final treated potable water produced.
f. Water source protection especially in rural areas –
This can be done through the excavation of surface
diversion channels to divert runoffs, fencing to restrict
unauthorized access for those using water ponds, and
where possible, further development of groundwater.
Open wells should be protected from anthropogenic
influences.
g. Home-based (residential) filtration – This should also
be considered for the rural and slum communities that
use highly contaminated surface water from ponds,
rivers, and other available sources. Residential filters
may be commercially available, but the locally made
units are cheaper and more affordable for residents in
rural and slum communities and thus are sustainable.
The use of residential/or point-of-use filters has been
successfully applied in rural areas for most developing
countries in Latin America with limited or no access
to piped municipal water supplies.
h. Continuous and systematic monitoring of water
quality parameters (both source water and treated
water) and assurances to meet the national water
quality standards.
Groundwater
Unlike in the U.S., Latin America, and the Caribbean where
groundwater is utilized extensively in both rural and
metropolitan areas for a range of applications, Uganda
still lags behind in groundwater resource utilization. To
realize more benefits from groundwater in Uganda, we
recommend several measures as listed below.
a. The groundwater resource utilization must be
extended for both rural and urban areas. Considering
the current quality of surface water, utilizing
groundwater would not only supplement the surface
waters but would also be financially beneficial to the
government because groundwater is usually cleaner
than surface water and will cost less money to treat.
b. In rural communities with no access to piped
water, more boreholes must be drilled to increase
accessibility to potable water. In some regions (e.g.,
Eastern and Northern), groundwater is almost the
only source of water for most parts of the year, and
water accessibility is still limited due to inadequate
number of water points.
c. There is a need for extensive health education
of the local populations on proper hygienic and
sanitary handling and maintenance of water sources.
People need the sensitization on how to keep their
groundwater sources safe. They must also learn
how to maintain hygienic and sanitary conditions at
home. Additionally, there is a need for strengthening
the government laws on community sanitation and
hygiene practices.
Rainwater
Rainwater provides a relatively good source of potable
water supply to communities in rural areas, but its use
in Uganda is still limited. In Latin American and the Car-
ibbean countries, rainwater has been used successfully
for domestic potable water supply and agricultural pro-
duction (58). In Brazil and Argentina, rainwater is used
extensively in semi-arid regions due to limited surface
water and groundwater resources; in Honduras, Costa
Rica, Guatemala and El Salvador, rainwater harvest-
ing using rooftop catchments has been used extensively
in rural areas for potable water supply (59, 60), where
there are no public water supply systems. Thus we rec-
ommend that importance be placed on several activities
listed below, which aim to effectively utilize rainwater
resources in Uganda:
a. The authorities must undertake extensive countrywide
campaign for rainwater harvesting, especially in rural
areas.
b. The Government must strengthen its initiatives
regarding the construction of communal rainwater
collection systems with adequate storage tanks to
 Nayebare et al.: Potable water issues in developing countries      13
supply households with limited access to potable
water.
c. Rainwater collection systems must be incorporated in
the state building rules for all the new buildings. This was
successfully implemented in Barbados, Turks & Caicos
Islands, Venezuela and Honduras, and demonstrated
tremendous success in enhancing water accessibility.
Consideration should be given to discharging the first
part of a rainfall to waste (or buckets for irrigation) in
order to improve the quality of the water collected.
d. Surface runoff must be collected and stored in low land
areas. This can later be used for other applications
other than potable water supply. This is currently
practiced in Paraguay, where low topography areas
(tajamares) are utilized for storage of rainwater and
later used for agriculture.
e. The authorities must conduct sanitation and hygiene
promotion on maintenance of storage tanks as well as
hygienic handling of water at home. In addition, the
interior of water storage tanks should be accessible
and easy to clean to prevent contamination.
f. All households should be encouraged to have some
water storage facilities installed so as to supplement
the communal rainwater systems.
An analysis of cost-benefit pertaining
groundwater resource development
Every year about 1000–1500 boreholes are drilled in
Uganda with a success rate approximated at 83% (61). This
Table 3 Estimating the cost of drilling a borehole in Uganda.
Item  
Direct costs  
 Casing/borehole components, staff payments, fuel, etc.  3,750,000  4,250,000
 Borehole location  
 Fuel for cars  
 Commissions  
  Subtotal  
Indirect costs  
 Profit, depreciation, commission, and % for otherwise     600,000
drilling successful boreholes (amount depends on %
success rate expected)
 Depreciation  
 Overhead  
  Subtotal  
  Total  
  Profit (min = 10%, max = 20%)  
  Total selling rate  
Note: The price quotations are stated in Ugandan Shillings.
implies that about 17% of the boreholes drilled in a year
dry up after a few months of operation. Considering the
cost of a single borehole (15.0 million Ugandan Shillings
(Shs.); 1.0 US$ = 2490 Shs.), much money has been lost in
the process. In order to attain an efficient, cost-effective
and sustainable development of the groundwater sector,
more qualified professionals are needed to carry out pilot
surveys to determine groundwater availability before any
drilling is done.
There is no fixed cost for drilling a borehole. Thus,
estimates based on the most current market rates are
typically used during budgeting. This estimation con-
siders both the direct costs (borehole components, staff
payments, fuel, etc.) and indirect costs (depreciation
and overheads). The direct costs are easy to estimate
and usually range from Shs. 5.6 to 8.1 million; however,
indirect costs are dependent on many factors like equip-
ment price and staff salaries. The total cost of drilling a
new borehole usually ranges from Shs. 7.5 to 15.2 million
depending on the contractor. Table 3 shows a summary of
the estimated cost of drilling borehole as adopted from a
report on assessment of groundwater investigations and
borehole drilling capacity in Uganda by Ron Sloots (61)
funded by the MWE and the UNICEF.
Considering the annual expenditure budget of about
Shs. 23.1 billion (62) for the NWSC to supply treated
water to the urban areas in Uganda, and comparing that
to the cost of drilling boreholes to abstract groundwa-
ter, it would be much less expensive to supply water to
the population if more attention is given to groundwater
resource development and utilization. The annual budget
Minimum  Maximum
 
300,000  800,000
500,000  1,500,000
1,000,000  1,500,000
5,550,000  8,050,000
 
  2,000,000
1,000,000  2,000,000
1,000,000  4,600,000
6,550,000  12,650,000
655,000  2,530,000
7,205,000  15,180,000
14      Nayebare et al.: Potable water issues in developing countries
of supplying treated water to urban areas is enough to
drill approximately 2000 boreholes. Although Uganda
cannot stop using water from the lakes for public water
supplies, supplementing surface water with groundwa-
ter and rainwater would help in monitoring the quality
of piped water by reducing the current burden on water
treatment plants. This would, in turn, make it possible
to incorporate better water treatment processes like
improved chemical disinfection methods and enhanced
filtration techniques using activated carbon filters or
slow sand filtration, so as to achieve better quality
potable water.
The development of groundwater coupled with
rainwater harvesting can promote water accessibility in
Uganda. As noted above, the issue of water accessibility
is worse in the rural and slum areas. In the urban areas,
where piped water connections are available, only about
71% of the population has access to quality potable water
(5). This implies that a significant proportion of the urban
proportion do not have access to the water, thus making
groundwater development an urgent and necessary
undertaking.
Expected benefits of improved accessibility
to good quality potable water
These expected benefits are listed below.
a. Improved quality of potable water would reduce or
eliminate the prevalence of waterborne diseases in
the country.
b. Medical care costs associated with the treatment of
water borne diseases would be reduced, thus boosting
the economy.
c. Workers would lose fewer work days to waterborne
diseases, thus increasing their overall productivity
and help boost the economy.
d. Increasing accessibility to water would mean less
time dedicated to obtaining drinking water from
the remote sources. This, in turn, will allow school
children to have more time for school and women to
actively participate in income-generating activities
because they are the ones who walk distances to fetch
water for their families.
e. The use of infiltration galleries and provision of
greater source water protection would help reduce the
costs associated with treating raw water, ultimately
saving the government significant fiscal resources
that can be utilized for other activities aimed at
boosting economic development.
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