The Vigilance of Patient Care Alongside Proper WASH in Healthcare Facilities
Busolwa Dispensary, located in Nyang’hwale District, is a small dispensary but serves a large population of around 15,000 people. The dispensary, community, and school in the village all profited from the ‘Canada-Africa Initiative to Address Maternal, Newborn and Child Mortality (CAIA-MNCM)’ project, and this demonstrates that through clean water, decent toilets, and good hygiene in healthcare facilities, is it not only the lives of mothers and newborns that can be improved but the lives of those delivering the services and working at the frontline of the dispensary. This includes the cleaners, nurses, midwives, and doctors. Water, sanitation, and hygiene have empowered these healthcare workers in their jobs, ensuring that they can deliver quality care to those who need it most. Before the project, Busolwa Dispensary had no access to clean running water. Relatives were asked to come with water if a woman was giving birth, and the nearest source was around 2-4 km away.
There was no incinerator for hospital waste, and there were two unimproved pit latrines, which were in bad shape. These outdoor squat latrines had to be used by patients, including expecting mothers and those who had just given birth. The challenges of water, good toilets and good hygiene in the health facilities complicated the accountability among the health workers in the facilities. “There was a time a woman came to deliver here, once the delivery was done, we told a relative that accompanied her to fetch water to clean the area where the delivery took place, but she did not get water at that time, so they had to leave with dirty clothes back home. And when they got home, those dirty clothes were not cleaned properly, and she used the same clothes to cover the baby the baby ended up getting sepsis, so it was hard to manage her but the source of it all was because she left with dirty clothes back home. For instance, if you look at the time when we did not have water, you just sweep the area outside, when mothers arrive for a clinic, babies/infants crawl there, on a floor that is not disinfected. These are two examples of the challenges that we faced at that time”- Joseph Siame, Clinical Office
Geita region was reported lagging on various indicators. According to the Emergency Obestic and Newborn Care (EmONC) needs assessment conducted in Western Zone, only 8-29% of health facilities had toilets and a shower connected to the labor room- a situation that made sanitation and infection prevention to be of a challenge (Ministry of Health, 2015). WaterAid Tanzania, through the CAIA-MNCM ‘Deliver Life’ project, improved access to clean water, decent toilets, and good hygiene at Busolwa Dispensary in 2018. The facility now has 24/7 access to running water, through a new borehole, and water tank. The water is treated which gets rid of bacteria. The dispensary has new handwashing stations installed so that healthcare workers and patients wash their hands with running water and soap.
Additionally, there are now improved toilets for staff and patients, and new waste disposal facilities, with an incinerator, placenta pit and ash pit available at the dispensary. All this has made life much easier and safer for Busolwa healthcare workers. Joseph Siame noted that the installation of the water system in the Busolwa dispensary is one of the major achievements that have increased cleanness and hygiene reduced the costs of buying water and further contributed to better facility operations and accountability.
This project has demonstrated that water, sanitation, and hygiene in healthcare facilities are powerful ways to improve the lives of healthcare workers. When healthcare workers work in a clean and safe environment, it improves their morale and their motivation to provide quality care. Ensuring that healthcare workers are empowered to do their job is fundamental to improving health outcomes, as they are the ones delivering quality care While all the above are admirable and intriguing, sustainability and expansion of project activities we implement often lack sustainability. The aspect of sustainability requires the commitment of the government from the national to the local levels and other key partners. Project activities require funds to be sustained and expanded. Therefore, it is recommended that the government should ensure that adequate funds are allocated and disbursed to cover the cost related to operations, maintenance, renovation, and expansion of these WASH facilities. Also, learning from this project, the healthcare facility governing committee needs to meet regularly to review their roles and make a follow-up of the WASH facilities to ensure the achievements made in WASH in HCF are sustained and expanded/replicated. It is WaterAid’s wish that water, good toilets, and hygiene are given a priority when it comes to budgeting, to ensure all HCF have access to water, and proper toilets and are facilitated with hygiene facilities to enable the facility environment clean and safe for use.