The heroes of Geita: empowering midwives through water, sanitation and hygiene
“Now, my smile has life in it,” said Regina Kasanda. “Our dispensary has enough water, new toilets and a bathroom for mothers to shower. We now have more women coming to give birth, and they even want to stay longer in the wards! Before [the project] the nearest water source was two kilometres away. Often, we worked in an unsafe environment, as there wasn’t enough water to clean the hospital or the medical equipment. You couldn’t feel at peace with your work.”
Regina’s experience of working as a midwife in an environment without water, sanitation and hygiene was not uncommon in Geita, a rural region in northern Tanzania. Scarce water supplies, frequent drought and hard-to-reach communities mean the issue of maternal and newborn health is an important one in Geita.
Quality healthcare was impossible without water, sanitation and hygiene
Without clean water, decent toilets and good hygiene, delivering quality healthcare was difficult, if not impossible – infections could spread easily, putting the lives of mothers, newborns and healthcare workers at risk.
In Geita, just
- 40% of women deliver with a skilled birth attendant
- 50% of births are in healthcare facilities
- 33% of healthcare facilities are equipped with adequate infection prevention control
The poor state of healthcare centres caused many women to choose to give birth at home. During the baseline study, mothers were asked why they did not want to give birth in a healthcare facility and they gave several reasons, including: no water available to bathe or clean sheets and clothes; poor hygiene; and inadequate hygiene protocols by healthcare workers.
Stories of women being discharged early for not having enough water, or walking home in the blood-stained clothes they gave birth in were not uncommon.
Without water to clean delivery beds and surgical equipment, nurses and doctors were unable to provide the services as well as they wanted to, and so did not feel happy or motivated in their jobs.
Nyaganga Juma Samuel, a midwife at Nyamalimbe Dispensary, said: “Without water there is a big risk of infections. Mothers used to bring water in buckets from home. During the dry season the nearest water source was around 5km away. We tried our hardest to make do with what we had. I felt very bad. If a mother would give birth during the night, I would have to take water from my home. The work was really hard – I was only able to do the minimum in my role.”
Poor hygiene led to routine antibiotic overuse, fueling antimicrobial resistance
With increased incidence of healthcare-associated infections, due to inadequate hygiene, it became normal for healthcare facilities in Geita to give antibiotics to every woman upon admission. This misuse contributes to the growing global threat of antimicrobial resistance – antibiotics should not be used as a substitute for good hygiene.
Improving water, sanitation and hygiene to transform quality of healthcare in Geita
For the past four years, WaterAid Tanzania, in collaboration with AMREF, have been transforming quality of care in Geita through improving access to water, sanitation and hygiene (WASH) in 12 healthcare facilities across the region.
The ‘Canadian Africa Initiative to Address Maternal Newborn and Child Health’, funded by Global Affairs Canada, aimed to improve maternal and newborn health through a comprehensive package of:
- Access to water through solar-powered rainwater harvesting and boreholes.
- Water treatment using UV sterilisation.
- In-facility handwashing basins, toilets and showers.
- A hygiene behaviour change campaign and messaging in schools, healthcare facilities and communities.
- Training for frontline health workers, including nurses and midwives, on maternal, child and newborn health.
- New maternity wards and theatres.
Twice as many women now give birth in healthcare facilities
The availability of essential WASH facilities, combined with the integration of infection prevention and control measures and training into day-to-day patient care, have empowered nurses and midwives with the tools and behaviours they need to provide quality, safe and skilled services. Healthcare workers are now able to keep the environment clean, and to practise good hygiene behaviours, such as handwashing with soap, thereby reducing their risk of spreading infections.
The midwives and nurses of Geita have noted that more women are coming to give birth at the healthcare centres and accessing important antenatal services, because they now feel happy with the services provided. Across five of the healthcare facilities involved in the project – Nyamalimbe, Busolwa, Kakora, Nyarugusu and Lwamgasa:
- The number of women coming to give birth has doubled.
- More women are accessing antenatal care.
- More women are accessing postnatal care.
- Zero cases of puerperal sepsis were reported, compared with 19 cases before access to WASH two years ago.
Celebrating the essential roles of nurses and midwives
The World Health Organization has named 2020 as Year of the nurse and midwife . This year, we celebrate the heroes of Geita – the nurses and midwives who have worked in incredibly difficult conditions, providing life-saving services. Now they are able to work in an environment which empowers them instead of limits them, they have helped to improve maternal and newborn outcomes for mothers and babies in Geita.
Globally, healthcare providers, including nurses and midwives, are the central, critical interface of healthcare systems. In Tanzania, only 39 nurses exist for every 10,000 people, and they work in some of the most challenging and risky conditions imaginable. This project has allowed us to witness the game-changing impact that access to WASH has on frontline health workers and on quality of care.
By ensuring that every healthcare setting has access to adequate WASH services, we ensure the safety and dignity of the people who devote their lives to the health of our mothers and children.
The lives of midwives and nurses in Busolwa Village have changed thanks to a WaterAid project, in collaboration with @AmrefCanada and @CanadaTanzania, which has improved access to water, sanitation & hygiene in the local dispensary. Regina said 'my smile has life in it now.' pic.twitter.com/ps4kEhubkj— WaterAid Tanzania (@WaterAidTZ) February 12, 2020
Read Results Canada's blog about Canadian MP's Marwan Tabbara and Lianne Hood's recent visit to the project to see the impact of Canadian aid.