I am really excited to tell you about a new project that Mary and I initiated at Save the Mothers in collaboration with one of our Global Health Corps colleagues. Jasmine Burton, a 2015-2016 GHC fellow with the Society for Family Health in Zambia, founded a social impact organization called Wish for WASH to bring innovation to the sanitation sector (read: toilets and stuff).
As you already know, Save the Mothers, through its Mother Baby Friendly Hospital Initiative (MBFHI), intervenes in health facilities to make small, but meaningful improvements in the quality, safety, and dignity of maternal and newborn health care. What you may not know is – water, sanitation, and hygiene (aka: WASH) is integral to safe motherhood. In other words, ensuring that patients and hospital staff have access to clean, safe, and functional toilets, as well as water and soap for washing, decreases the spread of disease and increases positive outcomes for mothers and babies.
I’ve written before about the dreadful toilet situations in many of the health facilities we’ve visited this year in Uganda, and most of our MBFHI facilities have identified improvements to their toilet facilities as a priority. So, we engaged Jasmine as a consultant to help us develop an assessment and evaluate our hospitals’ WASH-related facilities and practices. In May, we traveled to five MBFHI facilities, along with Jasmine who flew all the way from Lusaka, to conduct assessments, speaking with hospital administrators, health workers, cleaning staff, and patients. These visits illuminated a number of key issues that impact the cleanliness, functionality, and accessibility of toilets across the health facilities:
- Lack of consistent access to utilities: Water and power supplies are inconsistent here in Uganda, can be costly, and the infrastructure is often old and in need of repair. Without water, patients and staff cannot wash their hands or bathe, cleaning staff cannot clean the washrooms, and flush toilets cannot properly function. Lack of power or a generator in facilities that pump their own water means there is no water when the power is out.
- Misuse and malfunction of toilet facilities: Many patients are from rural communities and are unfamiliar with how to use flush toilets. They throw cotton pads and other large debris into the toilets (as they would in a pit latrine), causing the pipes to become clogged and leading to expensive maintenance and repairs – or eventual shutdown of the facilities.
- Overworked and underequipped cleaning staff: In many hospitals, cleaning staff are responsible for cleaning the entire facility, including the toilets, so toilets aren’t cleaned frequently enough. Most hospitals hire externally-contracted cleaners, who are underpaid, lack supervision, and aren’t provided with adequate cleaning supplies, protective gear, or direction.
- Lack of provision of basic necessities: In other words, no toilet paper, soap, toilet brushes, or dust bins. Why not? They get stolen.
- No facilities support for post-partum mothers, elderly, or people with disabilities: Imagine trying to squat over a hole in the ground when you’ve just had a C-section. Or in the middle of a contraction. Exactly none of the hospitals we visited had any equipment to accommodate post-partum mothers, elderly patients, or people with disabilities.
We’ve drafted a report, compiled recommendations, and are now searching for funding to address these challenges with solutions that range from behavior change campaigns to infrastructural improvements to national policy advocacy. I’m hoping to stay involved in this project, even after my fellowship year ends. There’s no end to the ways we can impact safe motherhood!