1.Hospital information

St. Joseph’s Hospital Kitgum is a 55 years old PNFP facility of Gulu Archdiocese, accredited by UCMB. The institution though is a general hospital; it serves as the major referral facility for the districts of Kitgum, Lamwo, parts of Pader, Kabong and South Sudan. The hospital has 280 beds with estimated population of 118,135 people within the allocated catchment area (4 sub counties). It has an annual recurrent budget of 4.2 billion.  



    2 .Where the hospital was

Up to 1994, the hospital was still using ordinary un-drainable pit latrines. The latrines exhausted the allocated land and there was no more space for further construction.

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    3.From ordinary pit latrines to drainable pit latrines

The exhaustion of land through digging ordinary pit latrines made the hospital to think of constructing drainable latrines which were costing the hospital 12.2 million every quarter to empty (48.8 million annually). Patients drop different materials including plastic bags in latrines and that require application of manual labor to remove it before an emptier vehicle is used.

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4.How the hospital improved

In 2008 the hospital came into partnership with Horizont3000, DKA and BBM to implement ecological rehabilitation project which focused on among other things human waste management.

The project constructed three types of toilets in the hospital; Composite toilet (2 blocks), Ecosan toilet (6 blocks), and urine diversion toile (6 blocks).                                                                                 

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                                                               Composite toilet which uses organic materials

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                                                                                   Ecosan toilet that uses organic materials

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The ecosan toilet has chambers where plastic wheelbarrows are placed to receive the fecal matter.

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This type of toilet (ecosan) employs the use of organic materials (preferably grasses or leaves). Plastic wheelbarrows are used to receive the fecal matter. The wheelbarrows have holes at the base to enable liquid to percolate through into the sewer lines. A thin layer of grass is packed at the base of the wheelbarrow before pushing it into the chamber; these are to ease the liquid elements to drip.The sewer lines runs to the wetland which is a kilometer away from the hospital.

Another type of toilet is Urine Diversion: This type of toilet uses ash for proper decomposition of the fecal matter. The users should apply ash after using the toilet. This would reduce the smell; hence no flies will be attracted. The urine line is connected to a tank and it’s collected to be used for plants as liquid manure. The toilet is incorporated in all the new hospital’s building plans.

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All the new buildings in the hospital have urine diversion system. New staff are inducted on how to use the system. Bakets are place into the chamber of the toilet to receive the fecal matter. Whoever uses the toilet must apply ashes. When the baket in the chamber is full, it’s removed and taken to pretreatment unit for empting. The fecal matter from the pre treatment unit is generated into manure.    

  1. 1.Pretreatment unit:

All the fecal matters from the different toilets are taken to a pretreatment section where they are shorted out. The pretreatment yard is 10 meter by 8 meter. The plastic materials and any other un-decomposed materials are shorted out and are taken for incineration. The fecal material plus the organic substances are generated into manure of different grades. The special grade which is in powder form is packed in branded bags for sale at 50,000/= for 50kgs, and the ordinary grade is sold at 50,000/= for 100kgs.



Different grades of manure is being generated (from far behind of the photo) and un-decomposed materials are being shorted out for incineration.  


Wetland is the point where all the water flows and undergoes purification process. The bed is made of fibrous, and on top it has aggregates and sands. The liquid substance from the toilets moves to the wetland through the sewer lines. The liquid from the wetland is filtered through the sands and the aggregates into the wetland bed and then it moves into an underground tank where it’s pumped using a motor. The water is pumped back to the hospital and it’s stored in tanks for reuse (watering flowers, oranges, and vegetables). The hospital is having plan of connecting the recycled water to all the flash toilets in the hospital.

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The elephant grass in the wetland is to reduce the over flow. It also serves as organic material to facilitate decomposition and generation of manure.

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The recycled water is stored in the tanks for reuse. Currently the water is used for watering plants on the compound. The compound is evergreen through the use of recycled water.


ward3 7.Common challenges of the system

Bad signs                                                                    Remedies

1. Pronounced smell                                1. Add more ashes or organic materials

2. Many flies / maggots                                   2. Check drainages and add more ashes organic materials

3. Wetting of the waste                               3. Seal off leaking roof and place the  

               Wheelbarrows correctly adjusted to the sewer lines.

4. Persistence misuse                            4. Lock the door & train the user on how to use          

   of the facility                                           the facility.

8.Disadvantages of the system over the ordinary toilet system    


  1. Requires skilled & committed operators
  2. Might not be convenience for visitors because it may require special orientation.
  3. May become a disaster in the events that the users remain stuck to negative attitudes.
  4. Production of manure may be hard in a situation of shortage of organic materials.
  5. Cultural practices looking at the use of ash on fecal wastes as taboo (prohibited traditionally)

9.What made the project to succeed in the hospital                                                       

  1. Donors’ commitment to finance the project and constant follow up of the project.
  2. Ownership of the project by the hospital (management and staff).
  3. Community / users acceptance to use the facility.  
  4. Self motivated staff.
  5. Management commitment to finance maintenance of the project.


Complied By:

Ochola Robert

Hospital Administrator

St. Joseph’s Hospital Kitgum

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