By David Inman, PE; Global Partnerships Senior WASH Technical Advisor at Water Mission
Handwashing with safe water is a vital resource for healthcare professionals in developing countries, like Kenya. Photo © Water Mission
Despite global efforts to provide water and sanitation solutions to healthcare facilities, almost 2 billion people worldwide depend on healthcare facilities without basic water services[1]. As a nonprofit Christian engineering organization that designs, builds, and implements water, sanitation and hygiene (WASH) solutions, Water Mission is working to serve vulnerable communities through sustained WASH provision. Our work to provide WASH in healthcare facilities around the world includes advocating for patient care, equipping frontline workers, strengthening health systems, and providing engineering expertise.
Advocating for patient care and safety: Improved maternal and infant health in Malawi
Safe water, functioning toilets, and soap must be present in all hospitals and health clinics to ensure the delivery of safe and dignified care. These fundamental resources help protect women and newborns during childbirth, allow for safe surgery, prevent antibiotic resistance, and contain pandemics. Every infection prevented is one that needs no treatment, causes no suffering, and imposes no economic burden.
Water Mission’s work to provide safe water to healthcare facilities helps raise the standard of care for patients. These efforts also increase a community’s confidence in the facility’s services.
When patients lack confidence in the safety of their healthcare center, they may avoid getting the help they need. The consequences can be dire. One example is the impact that lack of adequate care can have on mothers and newborns. When maternity care is unsafe or unavailable, women travel long distances to seek medical assistance or give birth at home without the aid of a skilled birth attendant. Unwashed hands, contaminated linens, unsafe water, and dirty instruments can transmit easily preventable, and sometimes deadly, infections to mothers and newborns.
Chiwe Health Center is a facility that serves 11,000 men, women, and children in the central region of Malawi. “Women used to travel over three miles to the nearest facility to deliver babies because such a service was not available at this facility,” Rick Kavolo, a healthcare worker at Chiwe Health Center, told us. “Some women were forced to deliver their babies along the way.” Then Water Mission installed a safe water system in Chiwe. It was finally able to offer maternity services. “The water system has changed our lives forever,” says Kavolo.
COVID-19 response
When COVID-19 began making its way around the world, Water Mission’s global staff quickly scaled up program efforts to provide handwashing stations, sanitation supplies, hygiene training, and COVID-19 awareness education. We provided critical hygiene supplies, such as safe water and soap, to more than 800,000 people around the world. We also installed more than 8,550 handwashing stations in key locations, including healthcare facilities, schools, and existing safe water collection points in Haiti, Honduras, Indonesia, Kenya, Uganda, Tanzania, Peru, Malawi, Mexico, and the Bahamas. To date, this program has equipped nearly 1,000 healthcare facilities with handwashing stations and training materials, ensuring that frontline workers are better equipped and protected as they carry out their critical work.
With the support of partners, Water Mission installed more than 8,000 emergency handwashing stations to help reduce the spread of COVID-19. Photo © Water Mission
A systems strengthening approach that protects patients and frontline workers
Efforts to improve health outcomes can only be sustained by continued investments in strengthening the overall health system. This, in turn, must include initiatives to improve access to adequate WASH services in healthcare facilities.
Providing safe water to healthcare clinics is an ongoing priority for Water Mission. In partnership with UNICEF and others, Water Mission provided safe water treatment systems to more than 25 hospitals, healthcare centers, and treatment units in Liberia between 2014 and 2018. This work started during our emergency response to the Ebola epidemic. Our efforts continued with the Ministry of Health as part of its systems-strengthening approach to help better prepare Liberia for future outbreaks.
Dr. Jeffery Deal, retired director of health studies for Water Mission, traveled to Liberia during the Ebola outbreak in 2014. He spent time in hospitals and treatment centers that were struggling to care for patients suffering from Ebola–especially without access to safe water. Upon his return, Dr. Deal later reflected on his experience:
“As a physician, I’ve worked in difficult circumstances around the world combatting epidemics of meningitis, cholera, malaria, and Ebola. My most vivid memories are from the time I spent during the height of the Ebola epidemic where doctors and nurses in Liberia did not have reliable, accessible safe water. Once, one of the units where I was working lacked sufficient water so that I could properly decontaminate my hazmat suit after working a shift…. Clearly, clean safe water is as important as the protective gear workers wear as they provide safe and dignified care.”
Doctors, nurses, midwives, aids, and those tasked with cleaning healthcare facilities must stay healthy. This is particularly true during a disease outbreak. WASH in healthcare facilities is foundational to preventing and containing epidemics and pandemics—and is required for global stability and economic growth.
A more recent example of a systems strengthening effort during COVID-19 is when Water Mission’s Tanzania program worked together with the Tanzania Ministry of Health to implement robust handwashing stations at more than 560 of their clinics throughout the country. The Minister of Health, Ummy Mwalimi shared her thoughts on the importance of this program, “The biggest thing that health professionals need to focus on is to ensure that they wash their hands to prevent contracting and transmitting infectious diseases. This initiative by Water Mission’s program in Tanzania ensures that happens.”
Safe water treated first by Water Mission’s safe water treatment system is then made available through emergency handwashing stations. Signs and instructions are translated in local languages as seen here in Honduras. Photo © Water Mission
Applying engineering expertise to respond to WASH needs in healthcare facilities
Understanding and meeting the requirements for adequate WASH facilities, practices, and infrastructure in healthcare centers is a complex effort. It combines knowledge and best practices from multiple disciplines, including public health, behavioral science, chemistry, microbiology, engineering, and education. For instance, water quality requirements in a healthcare center can vary based on its specific end use. Adhering to safe water requirements as defined by the World Health Organization (WHO) is a good starting point. Healthcare centers serve vulnerable populations, so multi-barrier treatment methodologies for water that combine multi-stage filtration processes and disinfection by both chemical and physical means are often appropriate. It is also important to conduct a thorough water quality and risk analysis of the water source to properly define a treatment plan.
More specific water quality requirements are further defined by medical equipment manufacturers. A good example are autoclaves used to disinfect medical instruments. These require water treated to remove minerals and other dissolved contaminants that can harm the equipment.
Medical instrument disinfection, laundering, and food preparation areas also require a thorough and comprehensive WASH plan to function well and serve the end-users. The first step is a technical assessment of baseline conditions in healthcare centers. From there, action plans can be developed to address gaps. WHO and UNICEF have developed a useful guide to aid in the assessment and WASH planning process for healthcare facilities.
Water Mission implements best in class WASH solutions that address healthcare facilities’ needs. For instance, a disinfection system we use in our programs around the world is the Water Mission erosion chlorinator. This device adds free chlorine residual to water as it is pumped from a groundwater source and stored in a tank, ensuring that all water distributed through taps and faucets is safe. With this solution, there is no need to batch-mix chlorine solutions every day, which can lead to inconsistent results. Instead, the device is simply refilled with chlorine tablets every few weeks.
For water sources with variable turbidity, Water Mission may use a multi-stage treatment system that includes flocculation, filtration, and chlorine disinfection. Many times, power reliability is a critical challenge at rural healthcare centers in developing countries. Water Mission is a recognized WASH sector leader in designing and implementing solar-powered pumping solutions that sustain water services despite a lack of reliable power.
A nurse in Torhonas, Indonesia, washes her hands with safe water before seeing patients at the health clinic.
Photo © Water Mission
Finally, water treatment solutions are only as effective as the systems in place to adequately and routinely test and monitor the water quality. Water quality testing can be done with simple, easy-to-use, low-cost products. Basic training empowers healthcare providers to test their own water and ensure it continues to be safe to use.
In closing, improving WASH in healthcare facilities does not hinge on scientific or technological breakthroughs, but on an integrated approach to WASH and health systems strengthening. At Water Mission, we are working to facilitate multi-stakeholder collaboration and community engagement and prioritizing WASH at the community, district, and national levels. Together, we can address the need for WASH in healthcare facilities around the world and solve one of the most serious issues facing global health.
Water Mission is a nonprofit Christian engineering organization, headquartered in Charleston, South Carolina, that builds WASH solutions in developing countries and disaster areas. Water Mission has extensive experience and expertise in implementing immediate and long-term safe water solutions following crisis situations, including infectious disease outbreaks.
[1] https://www.who.int/news/item/14-12-2020-almost-2-billion-people-depend-on-health-care-facilities-without-basic-water-services-who-unicef