WASH in HCFs data move ECSA Ministers of Health to action

Man washing hands

During the 69th ECSA (East Central and Southern Africa) Health Ministers’ conference, SNV – represented by Kumbulani Ndlovu and Mwangala Mulundano from Zambia – highlighted the instrumentality of water, sanitation and hygiene behind governments’ delivery of people’s basic right to health. Interventions were based on SNV’s WASH SDG baseline study that has contributed much-needed data to strengthen governmental commitment to WASH in health care facilities.

Selected by partners in Zambia’s national WASH in Health Committee,[1] Kumbulani and Mwangala delivered a presentation under the sub-theme, ‘Opportunities for achieving water and sanitation health global target: equity and access to eye healthcare in the ECSA region.’ Both explained to health ministers, senior government officials, representatives from international agencies, NGOs and private sector that the human right to health intersects with the human right to water and sanitation. They asserted that appropriate WASH facilities, services and know-how reduce health risks by enabling infection prevention and control to the benefit of patients, newborns or their mothers. And, the promotion and continuous (re-)training and (re-)skilling of HCF staff on key hygiene behaviours are likely to increase the credibility of public health programmes.

An uncomfortable silence

SNV’s presentation was followed by a long and uncomfortable pause. Breaking the silence, one participant noted that, ‘We had a sluggish response to your presentation as it shocked us and brought to the fore the gaps in WASH, particularly in our health care facilities.’

Added a former Minister of Health in attendance, ‘It is disappointing to note that we have neglected this priority issue way too long. Earlier we heard a presentation on eye care and health. Nowhere was the impact of water supply and proper sanitation mentioned. The SNV presentation was very good, albeit shocking.’

Data availability is key to mobilise support

According to the WHO/UNICEF WASH in Health Care Facilities report in 2019%20in%20health%20care%20facilities.&text=The%20report%20found%20that%20just,LDCs)%20had%20basic%20water%20services.), globally, an estimated 1 in 4 health care facilities lack basic water, and 1 in 6 lack access to hygiene services. It was noted that data gaps in many countries in ECSA are widespread. Lack of data has resulted in ‘significant gaps in the collective understanding of the status of WinHCF at the regional levels, with implications for programming.’ Available data were limited to water supply and toilets; less on hand hygiene, health care waste, and environmental cleaning; and none for safely managed sanitation, functionality of water supply, and accessibility measurements, e.g., for people with limited mobility.

During the ECSA conference, SNV presented the 2018 baseline findings of the team’s WASH SDG study on urban sanitation. The study explored citywide sanitation conditions across five towns in Zambia based on SNV’s Urban Sanitation and Hygiene for Health and Development approach. The study was part of SNV’s ongoing pledge to redress the dearth of significant data in sanitation and hygiene – valuable information that could shape policy making, prioritisation and resource allocation.

The SNV baseline study established that sanitation facilities in HCFs in the five project towns of WASH SDG fell within the ‘limited’ category, see figure 1.[2] Most sanitation facilities did not cater to the needs of people with disabilities, staff and patients were found to be sharing toilets, and most facilities were not equipped to facilitate the menstrual health and hygiene needs of women (e.g., providing adequate and suitable facilities for menstrual hygiene management). A snapshot of the five-town findings on access to handwashing with soap and a handwashing facility at points of care are shown in figure 2.

HCF access to sanitation, 2018
HCF access to handwashing

Placing WASH in HCFs in the ‘institutional radar’

Overall, SNV and partner interventions during the ECSA conference contributed to a strong resolve by decision-makers to:

  1. review and/or develop WASH country policies and strategies to incorporate the new SDG targets on access, equity and the new focus on safely managed services,

  2. promote multi-sectoral collaboration and encourage private sector investments in WASH initiatives,

  3. develop WASH regulatory frameworks (including standards) and ensure implementation and enforcement of the regulations, and

  4. strengthen WASH services in health facilities in line with the 72nd World Health Assembly (WHA) commitment.

Prepared by: Kumbulani Ndlovu (WASH Sector Leader in Zambia) and Mwangala Mulundano (BCC Advisor on Zambia)

Banner photo: Photo by cottonbro from Pexels

[1] Comprises MoH, MWDSEP, Water Aid, UNICEF, SNV, WHO
[2] Results rounded to the nearest 10th in both figures