Multi-stakeholder team responds to calls to improve WASH systems in Punakha’s health care facilities

In 2018, the World Health Organization/UNICEF Joint Monitoring Program team presented worrying trends and gaps in access to water, sanitation and hygiene (WASH) in health care facilities (HCFs). Disconcertingly the world began to understand that few countries accounted for WASH within HCF improvement plans, and vice versa – to the detriment of health practitioners, facility staff and patients. In the context of the COVID-19 pandemic, during the 73rd World Health Assembly, the world’s leaders amplified calls to urgently take appropriate measures to support access to safe water, sanitation and hygiene, and ensure infection prevention control.

In 2019, SNV assisted Bhutan's Ministry of Health (MoH) in undertaking its first national survey on WASH in HCFs. The survey sought to offer baseline data that could inform the country’s response for action. The data found that despite achieving 100% water supply coverage country-wide, a remaining 5% of HCFs in Bhutan did not have water at all times, and 15% had contaminated water. Similarly, although toilet coverage was high (99%) in HCFs, only 84% reported hygienic use; 30% had gender segregated toilets; and only 31% were accessible. Hand hygiene at points of care was 73%, while only 36% of HCFs segregated waste properly.

Parallel to the study and in collaboration with SNV and the World Health Organization (WHO), the Ministry of Health initiated activities in 2018-2019 to develop sustainable and scalable interventions that could potentially minimise risks of infection and disease spread in HCFs. Part of this effort has been to adapt the WASHFit methodology and its tools – designed by WHO with support from DFAT – making these more relevant in Bhutan’s context. As well, to develop capacity of health and local government officials to apply the adapted WASHFit.

‘Involving and engaging local leaders in the joint assessment of our BHUs have definitely helped local governments to plan, budget and support health care facilities better (in improving access to WASH facilities and services).’ - Locally elected sub-district leader, Punakha District

To date, 26 stakeholders comprising district health officers, health assistants, and support staff from nine HCFs in Punakha district have been trained by SNV advisors in collaboration with WHO/PHED. An outcome of these trainings activities has been the formation of a multi-stakeholder partnership tasked to champion WASH improvements in Punakha’s HCFs. Trained health assistants have committed to organise regular core group committee meetings to revisit action plans developed during the 1st WASHFIT assessment.

On the side of HCF management, decision-makers have agreed to set in place more regular intervals to review and update their respective action plans. District health officers have pledged to continue its monitoring role, and to facilitate WASH infrastructure and services improvements. To facilitate Punakha’s HCF alignment with national sanitation and hygiene goals, SNV and PHED had reiterated their commitment to continue providing technical and monitoring support.

Photo: Examples of drinking water supply and sanitation facilities in Dagana, Bhutan (SNV/Aidan Dockery)

Notes: This blog is part of the bi-annual success stories of the Beyond the Finish Line  - SSH4A in Bhutan project supported by the Australian Department of Foreign Affairs and Trade’s Water for Women Fund. It was written by Raj Kumar Bhattrai (WASH Advisor - Bhutan).