Moreover, the links between the voluntary sector and the state are becoming more, not less, important for service provision. Significant parts of water and environmental health services would grind to a halt in Kenya, Tanzania and Uganda if voluntary agencies did not have access to state-provided resources. Similarly, many voluntary organisations are run by or through state employees. This straddling between the state and civil society is a key feature of privatisation of water and health service provision in the region. Finally, donors play a growing political and financial role in the water and health sectors.
State services depend increasingly on donor resources, particularly in Tanzania and Uganda.
A key feature of privatisation of water and environmental health service provision in East Africa is therefore not just the increase role of the voluntary sector, but also the continued centrality of the state - and foreign donors. It is perhaps surprising that these trends are common to all three countries since each has followed a very different political trajectory since the heady days of the first East African Community in the 1960s. But past differences among them in the way water and environmental health services were provided are fast disappearing. In the short term, the most certain implication of these trends is that the role of the state and external support agencies is crucial for improving water and environmental health services in East Africa. Not only because state-provided services are significant in themselves, but also because without links to the state and donors, many voluntary sector services would cease to function.