The vigilance of patient care alongside proper WASH in healthcare facilities

Busolwa Dispensary, located in Nyang’hwale District, is a small dis­pensary but serves a large popula­tion of around 15,000 people.

The dispensary, community, and school in the village all profited from the ‘Canada-Africa Initiative to Address Maternal, Newborn and Child Mortality (CAIA-MNCM)’ project, and this demonstrates that through clean water, decent toilets, and good hygiene in healthcare facilities, is it not only the lives of mothers and newborns that can be improved but the lives of those delivering the services and working at the frontline of the dispensary.

This includes the cleaners, nurses, midwives, and doctors. Water, san­itation, and hygiene have empow­ered these healthcare workers in their jobs, ensuring that they can deliver quality care to those who need it most.

Before the project, Busolwa Dis­pensary had no access to clean run­ning water. Relatives were asked to come with water if a woman was giving birth, and the nearest source was around 2-4 km away. There was no incinerator for hospital waste, and there were two unimproved pit latrines, which were in bad shape.

These outdoor squat latrines had to be used by patients, including expecting mothers and those who had just given birth. The challeng­es of water, good toilets and good hygiene in the health facilities com­plicated the accountability among the health workers in the facilities.

“There was a time a woman came to deliver here, once the delivery was done, we told a relative that accom­panied her to fetch water to clean the area where the delivery took place, but she did not get water at that time, so they had to leave with dirty clothes back home. And when they got home, those dirty clothes were not cleaned properly, and she used the same clothes to cover the baby the baby ended up getting sep­sis, so it was hard to manage her but the source of it all was because she left with dirty clothes back home. For instance, if you look at the time when we did not have water, you just sweep the area outside, when moth­ers arrive for a clinic, babies/infants crawl there, on a floor that is not disinfected. These are two examples of the challenges that we faced at that time,” Joseph Siame, Clinical Officer.

Geita region was reported lagging on various indicators. According to the Emergency Obestic and New­born Care (EmONC) needs assess­ment conducted in Western Zone, only 8-29% of health facilities had toilets and a shower connected to the labor room- a situation that made sanitation and infection pre­vention to be of a challenge (Minis­try of Health, 2015).

WaterAid Tanzania, through the CAIA-MNCM ‘Deliver Life’ project, improved access to clean water, decent toilets, and good hygiene at Busolwa Dispensary in 2018. The facility now has 24/7 access to run­ning water, through a new borehole, and water tank. The water is treated which gets rid of bacteria.

The dispensary has new hand washing stations installed so that healthcare workers and patients wash their hands with running water and soap. Additionally, there are now improved toilets for staff and patients, and new waste dis­posal facilities, with an incinerator, placenta pit and ash pit available at the dispensary. All this has made life much easier and safer for Busolwa healthcare workers.

Joseph Siame noted that the installation of the water system in the Busolwa dispensary is one of the major achievements that have increased cleanness and hygiene reduced the costs of buying water and further contributed to better facility operations and accountabil­ity.

Mr. Siame added that this facili­tates on-time cleaning around the infrastructure, utensils and the staff can be questioned if did not clean as required compared to the situa­tion before when they did not have access to water.

“Prevention is better than treat­ment when we use a lot of energy in preventing and building improved infrastructures. We help patients and staff who are getting services here a lot in their daily economic activities instead of returning to the hospital regularly because of infec­tions. I highly commend the invest­ment that was made and request them to continue with the same spirit to improve the WASH infra­structures in HCF that do not have proper ones and be like Busolwa,” Joseph Siame, Clinical Officer.

This project has demonstrated that water, sanitation, and hygiene in healthcare facilities are pow­erful ways to improve the lives of healthcare workers. When health­care workers work in a clean and safe environment, it improves their morale and their motivation to provide quality care. Ensuring that healthcare workers are empowered to do their job is fundamental to improving health outcomes, as they are the ones delivering quality care

While all the above are admirable and intriguing, sustainability and expansion of project activities we implement often lack sustainability. The aspect of sustainability requires the commitment of the government from the national to the local lev­els and other key partners. Project activities require funds to be sus­tained and expanded. Therefore, it is recommended that the government should ensure that adequate funds are allocated and disbursed to cover the cost related to operations, main­tenance, renovation, and expansion of these WASH facilities.

Also, learning from this project, the healthcare facility governing committee needs to meet regular­ly to review their roles and make a follow-up of the WASH facilities to ensure the achievements made in WASH in HCF are sustained and expanded/replicated.

It is WaterAid’s wish that water, good toilets, and hygiene are given a priority when it comes to budget­ing, to ensure all HCF have access to water, and proper toilets and are facilitated with hygiene facilities to enable the facility environment clean and safe for use.