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Three water, sanitation and hygiene (WASH) support tools were applied to Kampala city, Uganda, to evaluate areas with the highest health hazard due to poor wastewater and faecal sludge management and to develop interventions to improve sanitation and reduce exposure. The Pathogen Flow and Mapping Tool (PFMT) assessed how different sanitation management interventions influence pathogen emissions to surface water using rotavirus as the indicator pathogen, while the HyCRISTAL health hazard tool evaluated how flooding and drainage infrastructure influence the presence of human excreta in the environment. The SaniPath tool identified common high-risk pathways of exposure to faecal contamination in food, open drains and floodwater. An overlap in high health hazard hotspot areas was identified by the PFMT and the HyCRISTAL tools. Across the city, the most important hazard sources were the indiscriminate disposal of faecal waste into open stormwater drains from onsite sanitation technologies, open defecation and the insufficient treatment of wastewater. The SaniPath tool identified drain water, floodwater, street food and uncooked produce as the dominant faecal exposure pathways for selected parishes in the city, demonstrating the presence of excreta in the environment. Together, the tools provide collective evidence guiding household, community, and city-wide sanitation, hygiene and infrastructure management interventions from a richer assessment than when a single tool is applied. For areas with high spatial risks, those practising open defecation, and for low-lying areas, these interventions include the provision of watertight pit latrines or septic tanks that are safely managed and regularly emptied. Faecal sludge should be emptied before flood events, direct connections of latrines to open storm drains should be prevented, and the safe handling of food and water promoted. The tools enhance decision making for local authorities, and the assessments can be replicated in

Various business models for fecal sludge emptying and transport have been developed to address challenges and their advantages have been documented; however, their evaluation has not been investigated. This study developed an evaluation framework, which was tested in informal settlements in Kampala for sustainable business models of fecal sludge emptying and transport. Through key informant interviews and stakeholder consultations, service delivery challenges from informal settlements in Kampala were identified and included in the framework, which were: high cost of emptying services, spillages, access to facilities, high operational costs and social stigma. The evaluation framework adopted six service criteria: Financial, Institutional, Environmental, Technological, Social and Scalability; these were further defined by fifteen service sub-criteria. The criteria were tested separately on eight business models—for mechanized (cesspool) and semi-mechanized (gulper) technologies. The key output of the evaluation framework (business model scorecard) revealed that two models (scheduled desludging and call center) for cesspool technology and three models (mobile transfer stations, scheduled desludging and call center) for gulper technology have high potential for service improvement in informal settlements. Scheduled desludging and mobile transfer stations can effectively optimize emptying services and subsequently reduce emptying charges, whereas the call center is critical for bridging service delivery., BT/Environmental Biotechnology