Water, sanitation and hygiene: the basics of infection control in Sierra Leone

The WHO/UNICEF report reveals inequalities in access to safe water, sanitation and hygiene

By Harriet Mason
A teenager washes her hand
UNICEF Sierra Leone/2016/Mason
08 May 2017

2.1 billion people, or 3 in 10 people worldwide, lack access to safe, readily available water at home, and 6 in 10, or 4.4 billion, lack safely managed sanitation, according to the newest WHO/UNICEF Joint Monitoring Programme (JMP) report.

For children, access to safe water, sanitation and hygiene not only keeps them alive and healthy, it also gives them a chance go to school and gain an education, it reduces inequalities, and creates a brighter future.

The WHO/UNICEF JMP report presents the first global assessment of “safely managed” drinking water and sanitation services. It reveals inequalities in those who have access to safe water, sanitation and hygiene within and between countries and regions.

NGELEHUN, Sierra Leone, 8 May 2017 – Nurse-in-charge Elizabeth Kadie Momoh at the Ngelehun Community Health Post has just finished checking a pregnant woman in the facility’s labour room and heads to a sink to wash her hands. Clean water gushes out as she opens the tap.

The availability of running water is taken for granted in health facilities in most parts of the world. But a year ago in this health post, it was, you could say, a pipe dream.

“We had a well but fetching water from it was very strenuous, especially when the water level was down,” said Elizabeth. “During some previous dry seasons we could not use the well because it dried up. We [staff and patients] had to find other wells and streams outside the facility to get water. When pregnant women came to deliver, they or their relatives had to go and fetch water to wash the equipment, clean the delivery room and launder their clothes,” said Elizabeth.

UNICEF Sierra Leone/2016/Mason

Haja Sillah holds her two-day-old baby boy she delivered at the Ngelehun Community Health Post in Kenema District, eastern Sierra Leone.

Lack of running water is bad news if you want to stop the spread of infection. Providing access to sufficient quantities of safe water, to facilities for the sanitary disposal of waste, and to sound hygiene behaviours are vital to reduce the spread of infectious diseases. 

Despite the challenges, these health facilities continue to be in high demand. The facility where nurse Elizabeth works serves a population of more than 5,800 people across six villages, attending to an average of 269 people a month (with over 60 per cent of them being children under the age of five).

Last year, UNICEF implementing partner SILPA, with funds from the Swedish National Committee for UNICEF, rehabilitated the facility’s toilets and water well, installed a water supply system, and built an incinerator (for burning of waste), all in line with the new WASH in health standards and guidelines under the Sierra Leone H.E. The President’s post-Ebola recovery priorities. The new water, sanitation and hygiene facilities, installed through UNICEF support, are well appreciated.

“Now we can wash all our equipment at the centre’s premises each time we use them. Our new mothers even have a bathroom where they can freshen up before leaving the delivery room,” said Elizabeth. “Other patients do not need to be reminded to wash their hands when they come here because they always meet soap and a bucket of water at each entrance of the facility.”

UNICEF Sierra Leone/2016/Mason

Nurse Elizabeth Kadie Momoh washes her hands in the labour room of the Ngelehun Community Health Post in Kenema District.

It’s in these sorts of improved conditions that a total of 279 deliveries were done at the facility between January 2015 and September 2016.

A few minutes from the centre, we met Haja Sillah who had just moved home with the two-day-old baby boy she delivered at the Ngelehun Health Post. “The improvement in the water and sanitation facilities at the centre really inspires us to go to there when we need to,” said Haja. 

“I had a better experience this time than I did when I went to deliver my older children. This time I was able to have a bath in the delivery room just after I gave birth. My relatives also had enough water and space to launder my clothes and that of my child. I was a little reluctant to leave because I felt so comfortable!” she said.

Nurse Elizabeth was also positive. “Now my motivation for the job has increased. I can even concentrate more on the job because I don’t have to worry about or spend time trying to fetch water for use at the facility or my quarters,” she said.

In a country where there are not enough trained health personnel to be stationed in communities, it is important to keep available personnel satisfied and motivated to stay in the job fighting to reduce the high rates of infant and maternal deaths.