WASH FIT: More than infection prevention
Investing in Water and Sanitation for Health Facility Improvement in rural communities
The morning commotion at Lura Health Centre in the Rumphi district can be seen from afar. Busy mothers with their babies bundled in colourful wrappers move from one room to another, accessing the facility's various under-five services.
The maternity ward is equally busy. It is filled with pregnant mothers passing the time as they wait for their babies to arrive.
Success Mkalira, the facility's senior health surveillance assistant, is eager to show us around. But first, he instructs us to wash our hands with soap before entering the hospital building. "Handwashing with soap is important in infection prevention; it helps to stop the spread of diseases by 50 per cent," he says.
Lula health centre is managed by seven permanent staff who treat approximately 120 patients per day, including pregnant women and children. "We used to have a lot of diarrhoea and scabies cases. The recurrence of these infectious diseases was a result of lack of hygiene and sanitation in the community and at the hospital," Success explains.
In a country where the majority of health facilities lack plans and budgets for improving water and sanitation, infection prevention is a concern. The lack of proper infection prevention practices compromises health workers' ability to provide safe and quality care to their patients. It also prevents people from seeking care and undermines staff morale –according to the WHO and UNICEF's "A practical guide for improving quality of care through water, sanitation, and hygiene in health care facilities".
WASH FIT (Water and Sanitation for Health Facility Improvement) tools help to improve infection prevention
UNICEF, in collaboration with Rumphi district hospital, has trained Lura health facility staff in the WASH FIT (Water and Sanitation for Health Facility Improvement) tool. As part of the training, the health facility was assessed in water supply, sanitation, waste management, hand hygiene and environmental cleaning, environment and climate change, and management and workforce. Gaps were identified, and a plan to close them with available financial and human resources was developed and implemented and tracked to sustain the improvements made so far.
The facility has installed hand-washing buckets and soap at all entry points following the assessment. Hand sanitisers have been placed at all points where health care workers interact with patients. No one is allowed into any of the health facility buildings without washing their hands.
The maternity wing has also transformed. All plumbing issues have been resolved. Unclogging blocked pipes has resulted in cleaner bathrooms and better-smelling wards. Now more pregnant women prefer to spend their time in the ward rather than outside, as was the case in the past. This is important because pregnant women are encouraged to come to the facility to wait to give birth two weeks before their due date.
The labour ward's waste management has also improved. The three-pail technique is being used to properly separate infectious and noninfectious waste for proper disposal. The equipment is always clean and sterilized, and the floors and walls are spotless.
"These days, I look forward to going to work. My office is clean and smells pleasant. The equipment is well-organized and easy to find, which is critical in an emergency. These small individual improvements that we have made will save lives," says Annie Mwandira, a Midwife Assistant at Lura health centre.
"The training and assessment process were enlightening. All along, I assumed that the hygiene practices in place were complete. However, the self-assessment indicated otherwise. We identified many areas that needed improvement. Our hand washing and waste management techniques were lacking, the plumbing system needed maintenance, water quality was good but not excellent, and the lack of proper rest among hospital staff needed to be addressed," said Success. "In the last few months, we have addressed most of these issues, and our working environment has improved tremendously, benefiting us and our patients. In order to sustain the improvements, we have incorporated WASH FIT in the centre's management plan," concludes Success
Collaborating with the community to sustain the improvements
The hospital grounds are clean, and the grass is well-cut. Community members who were part of the WASHFIT assessment and training take turns to keep it that way. Once every month, community leaders gather their members and conduct general cleaning at the hospital. They clean floors, walls, cut grass, remove cobwebs and ensure that rubbish pits and the incinerator are clean and well protected to keep dogs away.
"Our relationship with the community has strengthened. We all want to keep our families healthy and strong, so we work together to keep the hospital clean. Community members take turns to assist health workers in cleaning the premises," says Emmanuel Mwenelwanda, a volunteer at the health centre.
Blessius Tauzie, UNICEF Malawi, WASH Specialist, says the improvements made are essential for creating an environment that accelerates healing and supports the dignity of all patients, especially mothers, newborns, and health workers. The gaps, when left unaddressed, threaten the safety of patients and caregivers. In short, WASH is a critical foundation for improving quality across the health system and one way of directly contributing to the attainment of Sustainable Development Goals 3 and 6.