A step ahead: SNV’s strategic action to tackle the WASH in health care facilities crisis

Guest blogger: Alison Mcintyre, WaterAid Australia

Those of us who work on improving the safety and quality of health care through water, sanitation and hygiene can, during this week, smell the air of change in the air. Last Saturday, all UN Member States agreed to a resolution on WASH in health care facilities at the 72nd World Health Assembly. The resolution provides an important framework for, and commitment by, countries to urgently tackle the WASH in health care facilities crisis. This global commitment will drive progress towards addressing the needs of almost 900 million people who must seek care at health facilities with no water, and the 1.5 billion people who must seek care where no toilets are available.

While this global commitment is fairly recent, SNV has been a step ahead in planning their strategy and support to governments to tackle this crisis. Early May, SNV held their first global learning event on WASH in health care facilities. While SNV’s work has been focussed in strengthening WASH systems for many years - including schools and health care facilities - they’ve acknowledged that WASH in healthcare facilities requires news ways of working, new technical knowledge, and clear strategic planning. Their learning event delivered.

Held in beautiful Bhutan, the event brought together SNV and Ministry staff from eleven countries across Africa and Asia. Inspired by Punakha’s stunning dzong, rolling hills and fresh air, the enthusiasm and energy were palpable in the meeting room from Day 1.

When addressing WASH in healthcare facilities, it is not as simple as water, toilets and soap. We are challenged to think more broadly. How is waste managed in health care facilities? What waste is generated, where does it go? How are facilities cleaned? With what? Who does it? How should hands be kept hygienic? Soap and water? Gloves? Alcohol rub?

There was a broad spectrum of issues to tackle, and four days to do so. While each issue was deliberated on, three elements stood out.

Data to dollars

Just this year WHO and UNICEF released their first global SDG baseline data for WASH in health care facilities. Showing that conditions remain dire, the study mostly revealed major data gaps. To kick off SNV’s learning event, each country had prepared an analysis of their own WASH conditions, as were known. Not one country had a complete set of national data for all five JMP indicators. Everyone agreed: We can’t accurately design action unless we know what we are trying to change.

Equally as challenging is the task to finance WASH where gaps are known. During the lively debate held at the end of the week, we discussed how budgets should be managed: centrally or at facility level. While one side might have won the debate (sadly I didn’t leave a winner), the most efficient model remains unclear, similarly, how to prioritise where to first strengthen data collection and use: locally or nationally. With no clear set of answers, we agreed that data should be collected through existing health-related monitoring mechanisms, and be accessible for cross-sector decision making at district level.  With data systems strengthened, we can realise effective and sufficient financing.

The realities: access for all and managing waste

The highlight for all was the field visit to several health care facilities across Bhutan. I was fortunate to visit the National Referral Hospital. While the hospital showcased exceptional water supply and quality systems, as well as cleaning and hand hygiene, two key challenges emerged.

Challenge #1: Even when complex surgery and medical care were being performed, not one toilet was accessible to people with disabilities. There were elevators to ensure that people could access the multi-story building, but no spaces for people with disabilities to relieve themselves with dignity.

Challenge #2: While sophisticated waste collection and treatment systems were in place, rapid urbanisation was reducing land and transport capacity for waste management and treatment. Highlighting that even with hospital care planning, other actors must be engaged to secure safe management of waste.

When all groups shared their field visit reflections, each showcased the same two issues. To address these, toilet accessibility for challenge #1 is a quick win. Small adjustments can be made to ensure that everyone has access to the sanitation facilities they need. Waste in challenge #2 is more complex as the environment must be considered, particularly in Bhutan, where restrictions on burning exist. Nepal showcased their learning on clean technologies, which served an inspiration for all. The challenge now lies in funding, and taking approaches/ solutions to scale.

The task ahead

The learning event exposed us to the challenges we are facing at health care facilities, and revealed what remains to be done. We have technical solutions, but they are not always well shared or known. We must be creative and challenge ourselves to work in new ways, with new partners, within and through the health sector to sustain change. To do all of these, we must learn.

I hope this is the not the last of SNV’s global events, and indeed should be an example for all tackling this issue. We need to expand such learning initiatives, make them cross-sector, cross-country and innovative, if we are to really sustainably improve WASH and health for all.

About the author: Alison Macintyre is WaterAid Australia’s Technical Lead for Health. She leads WaterAid Australia’s strategy, policy, research and programming on the intersection of water, sanitation and hygiene with human health. Alison supports health-related research, programming and policy work in the South-East Asia and Pacific regions, and is involved in WaterAid’s global policy and advocacy efforts. Her main areas of focus are WASH in health care facilities, maternal and newborn health, quality universal health coverage, nutrition and antimicrobial resistance.

Photos: Snapshots of the SNV learning event on WASH in Health Care Facilities by Tashi Dorji/ SNV.

The learning event in Bhutan was facilitated as part of SNV’s SSH4A programme, with support from the Department of Foreign Affairs and Trade of the Australian Government's (DFAT) Water for Women Fund - which is active in SNV in Nepal, Bhutan and Lao PDR - and UKAID of  the Government of the United Kingdom.