Exploring waste stream technologies and management models: WASH in HCFs learning event

Access to safe drinking water, sanitation and hygiene determines good health (WHO, 2017). Hence people’s right to health is inextricably linked to their right to water and sanitation. Both rights, among others, strengthen (or weaken) the conditions for people to lead a humane and dignified life.

From 6-9 May, almost 50 international WASH experts engaged on the topic of WASH in health care facilities (HCFs) at a learning event in Punakha, Bhutan. Below, Gabrielle Halcrow – participant and Multi-country Programme Manager of the Water for Women-supported Beyond The Finish Line programme in Bhutan, Lao PDR and Nepal, and Alex Grumbley – participant and WASH Sector Leader in SNV in Mozambique highlight the key points arising from the final learning block of the event.

Health care waste management standard operating procedures in place, but adherence has been low

Validating stumbling blocks identified during the April e-group discussion, unsafe disposal practices along the entire management chain, unregulated transport practice, and limited treatment protocols were all found to place great pressures and health risks on the overall well-being of health care workers, waste handlers, and the general population.

For example, whilst waste was segregated at point of treatment, all waste were mixed and incinerated in dump sites of some countries. It has not been uncommon to hear health care workers themselves say “What is the logic of segregating waste when they’re mixed and burnt altogether anyway?”.

In part, attitudes and poor segregation and handling practices of people in the frontline of health care were to blame. But, weak links between national and sub-national (local) government sanitation policies and arrangements have also contributed to disjointed enforcement, regulation and monitoring; further entrenching poor sanitation behaviours. For example, the purchase of sanitation supplies by some health care facilities in rural areas depend heavily on local government.

Coined as the ‘missing middle,’ the key role played by local governments in ensuring sanitary and safe practices within health care facility service delivery deserves greater attention. Addressing the ‘missing middle’ could potentially lead to an increase in appropriate sanitation facilities and equipment (and budgets); improved WASH regulations and waste management practice; as well as regular training and re-training opportunities to facilitate a fundamental shift to positive sanitation behaviours.

Going forward to leave no HCF behind

A paradigm shift is needed if we are to leave no HCF behind. This, as participants of the learning event and the e-group discussion shared, will include:

• revisiting how waste stream investments are organised along the entire sanitation chain;

• changing the organisational structure of waste streams, e.g., setting up waste management areas with an incinerator, a waste pit, a transit storage area, a placenta pit, fenced inside the HCF;

• effecting a more rigorous system of supervision waste treatment and disposal, by e.g., HCF line managers; and

• strengthening the practice of HCF waste reuse and recycling, e.g., transforming HCF waste generated by hospitals to (biogas) energy.

What are some other proven WASH methods or recommendations to improve the sanitation conditions of HCFs? Stay engaged and consider sharing these in the SNV WASH e-group.

This blog is the final instalment in the three-part participant account of the learning blocks tackled during the learning event, WASH in Health Care Facilities. Earlier blog accounts are: Setting the scene: WASH in HCFs learning event, and Entry points for change: WASH in HCFs learning event.