Dr. Moses Ntaro, photo credit: Makerere School of Public Health
In a world racing toward artificial intelligence, digital health innovations, and breakthroughs in the fight against HIV/AIDS, malaria, and other major diseases, Dr. Moses Ntaro chose to focus his doctoral research on something far more fundamental—where people relieve themselves.
For him, the decision was neither abstract nor academic. It was personal, practical and impossible to ignore.
Ntaro, who is graduating with a PhD in Public health at Makerere University’s 76th graduation, first confronted the scale of open defecation not through policy documents but through village footpaths in southwestern Uganda.
As Assistant Coordinator of Community-Based Education at Mbarara University of Science and Technology (MUST), he supervised health profession students placed in rural communities under the Community-Based Education, Research, and Service (COBERS) model.
Part of their learning involved transect walks—systematic walks through villages to observe sanitation conditions, water sources and environmental risks.
What they saw was striking.
Students pointed out bushes behind homes, worn paths leading away from compounds, and open fields used for defecation. Later, in health facilities, Ntaro reviewed clinic records showing high rates of diarrheal disease, intestinal worms, and recurring infections among children.
The connection was direct.
“The effect was evident in the high prevalence of intestinal infections we saw in health facility records,” Ntaro recalls.
At the national level, Uganda had already adopted Community-Led Total Sanitation (CLTS) in 2007 to eliminate the practice through collective behaviour change. Globally, Sustainable Development Goal 6.2 commits countries to end open defecation by 2030.
Yet in many rural communities, progress was slow.
Ntaro had worked as an Environmental Health Officer under the Ministry of Water and Environment. He understood sanitation from both technical and policy angles. But he also saw a gap between strategy and sustained community change.
What puzzled him most was this: students were already present in these communities for weeks at a time. They were trusted, energetic, and trained in public health. Yet their presence was not being systematically used to accelerate sanitation transformation.
That question lingered: Why aren’t we intentionally using students to drive sanitation change?
His PhD sought to answer it.
Rather than treating open defecation as a statistic, Ntaro examined how student-led engagement could influence Open Defecation Free (ODF) status in rural Kabale District.
The baseline findings were sobering. Only a small fraction of households were truly Open Defecation Free (ODF). Many still lacked consistent latrine use, proper maintenance, or handwashing practices.
More revealing, however, were the underlying drivers.
Sanitation status was shaped not only by income but by behaviour, social norms, and household dynamics. Clean compounds, maintained latrines, and habitual handwashing were strongly associated with sustained Open Defecation Free status. Male-headed households showed higher odds of being, reflecting the role of decision-making power and resource control within families.
“Factors associated with Open Defecation Free status were not just economic,” Ntaro explains. “They were behavioural and contextual.”
This insight shifted the focus of his intervention.
In some communities, traditional health extension workers led sanitation activities. In others, trained students facilitated triggering sessions, follow-ups, and household visits. The difference was not dramatic infrastructure investment but consistency.
Students returned. They checked progress. They built relationships.
The results showed that villages supported by students saw greater improvements in Open Defecation Free status—and at lower cost per household.
But for Ntaro, the deeper motivation went beyond comparative effectiveness.
Discussing open defecation in 2026 feels unsettling, he says, because it reflects a deeper failure of dignity. In an era of technological leaps, many families still wake before dawn to seek privacy in bushes. Women and girls face safety risks. Children face preventable illness. Families lose productivity to disease.
“Open defecation is not simply a sanitation issue,” Ntaro says. “It is linked to poverty, nutrition, and broader development.”
Studying it was, for him, a way of confronting a contradiction: how can societies celebrate progress while leaving basic human needs unmet?
With the 2030 deadline to end open defecation drawing closer, Ntaro’s research offers both critique and possibility. The tools exist. The strategies exist. The human resource — students embedded in communities — already exists.
First published by Makerere School of Public Health. Read original story.