Stronger systems, better services!

Published on: 27/02/2024

As governments and organisations continue to push towards achieving the Sustainable Development Goals by 2030, actors in the water sanitation and hygiene sector now know that all the parts of the system are interconnected and must move in sync to deliver safe equitable and resilient services for everyone, for good.

Kaswa Health Centre III in the heart of Kabarole, western Uganda attracts quite a population lately. Apart seeking healthcare services, politicians and service operators flock the facility to learn about the outstanding WASH installations that are being done in the center.

"It may seem quite normal that all over the country patients and health facility staff carry a small water container for personal use while at the health centre. But it is the most painful and embarrassing sight when newly delivered mothers bathe from out here in the open because there are no bathrooms or running water at the facility," says Norah Kabahenda, Nurse In-Charge at Kaswa HCIII in Kabarole.

That is now in the past. Kaswa has had a piped water supply network installed on the premises connecting to wash basins inside the treatment rooms and wards. There are safe drinking water containers stationed in the waiting areas. A new sanitation facility with emptiable pit latrines, cleanable floors, lockable doors and separated for men and women, bathrooms for women and urinals for men is under construction. Kaswa HCIII and others under IRC's programme have been transformed into model centers of WASH in healthcare facilities, to demonstrate the acceptable standard of services for Uganda as prescribed by the Ministry of Health National Guidelines for WASH in Healthcare Facilities.

IRC is using the WASH FIT service delivery model to transform nine healthcare facilities that have become points of learning for Health Unit Management Committees. The district technical health teams say that the communities are now more receptive of health and hygiene outreach activities because they see and experience the difference in services.

"We have seen a gradual reduction in diarrhea diseases at the health facilities that are benefitting from this model, we now need to document data from the surrounding community to get clear lessons of how health and hygiene has changed since the project began here," says Cecilia Birungi, District Health Inspector, Kabarole.

Political elected leaders have particularly embraced the model WASH in healthcare initiative because it makes the impact practical at all levels.

"We have had partners who construct structures that we do not know how to use. Others give skills that we cannot apply because we do not have facilities. The unique thing about modelling is that it combines tangible facilities that we can see and use, with knowledge and coordination to help us replicate. We now have peer-to-peer visits between health facilities and where one has challenges, it is an opportunity to learn from others," says Hon. Balinde Restitute, an elected local councilor and Secretary of Health on the District Executive Committee Kabarole. 

Balinde adds that leaders are now more motivated to lobby for direct WASH in healthcare budget allocations and have scaled-up demand but to make sure that all healthcare facilities in Kabarole have full WASH services in place.

Interventions are aligned to the district's needs, with guidelines and specifications managed by the District Water Officer. The health department technical officers prepare and facilitate training sessions for Infection Prevention and Control and Health Unit Management Committees while IRC only supports the process.

"Things that were considered minor and do not require external funding such as labeling facilities according to gender and disabilities are now included in the plan and prioritized," says Bruno Basudde District Water Officer, Kabarole.

The initiative is drawing attention of government, partners and investors away from solely focusing on building infrastructure, while neglecting commensurate planning and budgeting, good governance, and operations and maintenance framework to make the services sustainable.

"Our district work is far from intervention but is purely a collaboration. It is through the active relationship with the district leadership being guided by the WASH Masterplan that we get direction on how and where to support. While we do not have huge funding to respond to all the service gaps, we strengthen the different aspects – the council to front pro-WASH policies, and the planning and technical departments to use evidence. The models are examples that we believe will help the district and the country mobilize more investment in WASH in healthcare services," says Jane Nabunnya, IRC Country Director.

Beyond the direct impact on quality of life for the people served, resilient WASH systems have a ripple effect on other sectors such as environment, energy and climate change, as well as far-reaching impact on broader socio-economic development in the districts.

"Even though we still struggle to budget for sanitation within the limited grant, our Kiko Town Sanitation Plan has helped us to make some steps forward. We are demonstrating return on investment of the public sanitation facility in the town," says Michael Mwesige Akiiki, Town Clerk of Kiko.

It is thanks to these demonstrable outcomes of WASH systems strengthening such as the Town Sanitation Plans that the Kabarole District Sanitation Ordinance has been finalised and legalized by council. "That means politicians are now our allies in delivering the change we want," adds Mwesige.

The gap is still enormous but collective action through the WASH Agenda for Change consortium and flexible funding from The Waterloo Foundation, the Conrad N. Hilton Foundation, The Osprey Foundation and the James Percy Foundation have allowed IRC not only to consolidate impact in the districts but to establish reference for the case for systems leadership.

"We would never claim to have all the answers, if any at all. We are happy that despite each organization's distinct programming, we can contribute through this [WASH Agenda For Change] consortium to allow you and your partner districts consolidate multiple approaches to achieve the same goal," Dr Tabitha Ndiaye, World Development Fund Manager at The Waterloo Foundation.

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Tabitha Ndiaye of the Waterloo Foundation (2nd left) on a visit with WASH Agenda for Change district partners at Kiko Town Council