Overview:
He has found that university students can play a critical role in accelerating progress toward Open Defecation Free (ODF) communities in rural districts in Uganda. Ntaro’s PhD thesis was titled “Effect of Student Community Engagement on Open Defecation-Free Status.
For Uganda, a country whose millions of citizens still practice open defecation, it must use students to go into communities and sensitise them against this vice, Dr. Moses Ntaro has recommended. Dr. Moses Ntaro, a lecturer at Mbarara University of Science and Technology, is graduating from Makerere University’s 76th graduation ceremony with a PhD in Public Health.
He has found that university students can play a critical role in accelerating progress toward Open Defecation Free (ODF) communities in rural districts in Uganda. Ntaro’s PhD thesis was titled “Effect of Student Community Engagement on Open Defecation-Free Status.” His research examined whether health profession students deployed under the Community-Based Education, Research, and Service (COBERS) model could effectively support sanitation behavior change in rural communities.
Uganda adopted Community-Led Total Sanitation (CLTS) in 2007 to combat open defecation through collective behavior change rather than hardware subsidies. Despite nearly two decades of implementation, progress has been uneven, particularly in hard-to-reach rural areas.
Ntaro, a lecturer in community health who previously coordinated a community-based education programme, first came face to face with the problem of open defecation in Kabale District, where he led health professional students in community-based education programmes. Walking around villages year after year, he said, they found many cases of open defecation.
For his PhD, Ntaro surveyed 492 residents in Kabale District. His findings revealed that only 3 percent of households met the criteria for being fully open defecation-free. The average respondent was 49 years old, and nearly 30 percent had no formal education.
Most respondents were women, who often bear primary responsibility for household hygiene. Ntaro said one of the key factors contributing to the lack of toilets in the hilly rural areas of Kabale District is that they are often washed away by heavy rains, discouraging residents from reconstructing them repeatedly.
Ntaro’s PhD study identified several factors associated with Open Defecation Free status, including male-headed households, clean compounds, well-maintained latrines, and consistent handwashing practices. Ntaro said sanitation outcomes were shaped not only by access to facilities but also by behavioral and contextual influences.
In his study, to test alternative approaches, Ntaro compared villages where traditional health extension workers led sanitation efforts with those where trained university students facilitated community education. The students conducted community “triggering” sessions, follow-up visits, and household engagement over several weeks. They were also strangers, unlike traditional health extension workers who are known in the communities and may not effectively trigger change.
The results showed that villages supported by students achieved higher rates of ODF status than those using traditional approaches. In addition, the cost per household was lower when students were involved. “Students were more effective, and they were a cheaper human resource,” Ntaro said, emphasizing that their sustained presence and repeated follow-ups were key to building trust and reinforcing behavior change. It is estimated that over 20 percent of Ugandans still practice open defecation, and more than 1.7 million people do not have toilets.
Globally, more than 350 million people still practice open defecation, with sub-Saharan Africa bearing a significant share of the burden. Open defecation is closely linked to diarrheal diseases, intestinal worm infections, malnutrition, and stunting, particularly among children.
With only four years remaining until the 2030 deadline to end open defecation, Ntaro argues that universities offering public health-related courses should be formally integrated into district sanitation planning and budgeting processes. That may not end open defecation before 2030, but it will put the country on track to eliminate the practice beyond the set deadline.
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