Devex interviewed BHI’s Civil Engineering Specialist, Paul Avery about BHI’s unique approach to designing, implementing, and maintaining wastewater systems at health facilities in low-resource settings. Read the full article here.
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Practical tips for improving WASH in health care facilities
Amid the pandemic, calls have been made to bolster WASH facilities in places such as schools and health care facilities after deficits were made glaringly obvious by COVID-19.
One in four health care centers around the world have no hand-washing facilities, and in the lowest-income countries, almost half have no clean water.
“Especially in the health systems strengthening sector, [WASH is] often an afterthought even though it’s like the ground floor of everything,” explained John Sauer, senior technical adviser on WASH at Population Services International.
That deficit means that over 1 million deaths can be linked to unclean births each year, while out of 10 out of 100 hospitalized patients in low- and middle-income countries will acquire a health care-associated infection. Untreated wastewater and fecal sludge from health care facilities — which can contain antibiotics as well as resistant pathogens and genes — also increase the potential for antimicrobial resistance.
To remedy this, in 2019, health ministers signed a resolution on water, sanitation, and hygiene in health care facilities, committing to the development of national road maps, setting targets, increasing investments, and strengthening systems. In 2018, United Nations Secretary-General António Guterres also made a global call to action for achieving WASH in all health care facilities.
While much of this work relies on funding that’s often in very short supply — fewer than 14% of countries have the resources needed to implement WASH plans — and progress can be slow, Devex asked experts what first steps new and existing health care facilities can take to improve their access to WASH and ultimately save more lives.
1. Build maintenance capabilities
“Usually when [health facilities] don’t have the basic WASH services it’s because they may have had a water system in place but that has broken down,” said Zoe Pacciani, director of operations at the Freshwater Project International, adding that the first thing to do is diagnose the source of the problem.
While someone might then be able to repair them, Pacciani said that a lack of local maintenance could mean it continues to be a challenge.
Paul Avery, a civil engineering specialist at Build Health International — an organization that has helped to build health infrastructure in hospitals in places such as Haiti, Liberia, and Niger — said a lack of maintenance staff prevented the team from rolling out a sanitation system in the Maternal Center of Excellence at Sierra Leone’s Koidu Government Hospital.
“Through a series of tanks, vessels, chambers, and whatnot [the wastewater system] treats the wastewater to a point that it’s okay to discharge it to the surface, but we can’t do that there because there’s nobody who can operate and maintain it,” he said.
A lack of budget and the absence of an institution that takes responsibility for maintenance from a financial perspective is a problem in many places, Pacciani said. In Uganda, 3% of the national budget goes toward water and environment — an area that is not budgeted for in health care facilities.
The introduction of the world’s first water futures market has civil society organizations worried about the threat it poses to water as a human right.
At the national level, WASH in health care as a specified budget line should be advocated for, Pacciani said. “If this is done, there’ll be no ambiguity about how those funds are intended to be spent and, as a result, funding will be available for the installation, improvement, and maintenance.” On a local level, she said charging a small fee at a health care facility, either for water collection or health care services, could provide funds for maintenance.
The development of the local private sector could also help, Sauer suggested. “In a lot of areas there isn’t a janitorial service to be able to subcontract to a health care facility to do ongoing cleaning, operations, and maintenance so if private sector entities were developed more, then you could have those kinds of services,” he said.
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