Health & Medicinearticle2026-10-02

Assessing the sustainability of ecological sanitation in Kabale, Uganda, using an analytical hierarchy process–based approach

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Abstract

ABSTRACT Graphical abstract showing the assessment of EcoSan sustainability in Kabale District, Uganda, using a multi-criteria analysis approach based on health, technical, environmental, socio-cultural, economic and financial, and legal and institutional criteria. This study evaluated the sustainability of ecological sanitation (EcoSan) systems in Kabale Municipality, Uganda, using a multi-criteria analysis framework based on the analytical hierarchy process (AHP). Although EcoSan is widely promoted as a low-cost sanitation solution, its long-term sustainability remains insufficiently understood in many developing-country contexts. A mixed-methods approach combined household surveys (n = 108), focus group discussions, key informant interviews, field observations, and a literature review. Sustainability criteria and indicators were identified from the literature and validated through a structured stakeholder workshop. The AHP-derived weights were obtained using pairwise comparison matrices, with consistency ratios below 0.1 (consistency ratio < 0.1) ensuring reliability. Sensitivity analysis was conducted to evaluate the robustness of the results. Six dimensions were assessed: health, technical, financial, environmental, socio-cultural, and legal–institutional. Health (18.8%) and technical (18.7%) ranked highest, while legal–institutional aspects (15.0%) ranked lowest. The sustainability index was 79.7%, indicating sustainability but highlighting vulnerabilities in affordability and long-term financial viability. Sustainability is constrained by cost barriers and reliance on external support mechanisms. The study provides a context-sensitive assessment framework and actionable policy insights. Core indicators, including affordability, limited institutional support, low user compliance, inadequate operation and maintenance, and weak monitoring, continue to jeopardize the long-term sustainability of EcoSan.

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View paper (DOI)Open access versionOpenAlexJournal of Water Sanitation and Hygiene for DevelopmentPublished 2026-10-02

Authors: Dominic Banaga Mucunguzi, Richard Joseph Kimwaga

Institutions: University of Dar es Salaam