Even though the World Health Organisation (WHO) says forty percent (40%) of all Out-Patient Department (OPD) reported disease cases can be prevented through the provision of Water, Sanitation and Hygiene (WASH) facilities many Health Care Facilities (HCF) in developing countries including Ghana still lack access to reliable hand washing facilities and safe drinking water.
The WHO again has estimated that over half of HCFs in developing countries lack access to hand washing facilities consequently; the risk of Healthcare-Associated Infections (HAIs) in developing countries is approximately 2–20 times greater than in higher-income countries.
According to available data from the WHO, poor hand hygiene in healthcare facilities is a long-recognized risk factor for HAIs. Additional barriers to performing adequate handwashing include healthcare worker acceptance and limited patient participation and empowerment. Access to safe drinking water for the oral administration of medications is also a related problem.
Using contaminated drinking water to provide medications, including anti-tuberculosis drugs, de-worming medications, first doses of antibiotics for common infections, zinc and Vitamin A, and oral rehydration solutions can increase the risk of enteric infections in all patients.
One potential solution that has proven feasible includes installation of inexpensive, portable, handwashing and safe drinking water centers; distribution of starter supplies of soap and water treatment products; and healthcare worker training on safe water and hand hygiene
In recognition of these problems, the WHO/United Nations Children’s Fund (UNICEF) Joint Monitoring Programme (JMP) have proposed for the post 2015 Sustainable Development Goals (SDGs) that by 2030 all HCFs should have an improved water source and hand washing facilities that have both water and soap available for handwashing near food preparation, sanitation, and patient care.
To help Ghana government achieve these set targets, WaterAid Ghana (WAG) with support from the Global Affairs –Canada have designed a well thought through five year project dubbed “Water, Sanitation and Hygiene for Public Health (WASH4PH)” to provide total WASH for HCFs, educational institutions and households to address the water and sanitation problems in Bongo and Kassena Nankana West in the Upper East region.
A visit to some of the beneficiary communities, HCFs and educational institutions revealed that the five year project which began in 2015 and ended in December, 2019 in the two districts have not only brought huge relief to the good people of Bongo and Kassena Nankana West districts but have also created environmental entrepreneurs.
According to the Programme Manager- Technical at WAG, Mr. Sampson Aheleh Tettey, WASH4PH seeks to protect the health of patients and staff through improved access to handwashing facilities and safe drinking water in HCFs, schools and the communities his outfit operates in.
Today, people in the two of the most hardest hit districts with this problem of lack of access to safe drinking water let alone to talk of reliable hand washing facilities through this timely intervention by WAG and its partners have access to not only reliable safe drinking water, but have decent toilets as well as handwashing facilities at homes and institutional/organisations.
Mr. Aheleh Tettey speaking in an interview with Today, said the WASH4PH project which have been implemented in 12 HCFs, 32 educational institutions, and 42 communities in the two districts has become a model for the remaining districts in the Upper East region.
He explained further that the WASH4PH project was to be in just 15 schools, eight (8) HCFs and some 20 communities but due to a couple of factors like: high fluoride content in water found in most of the targeted communities and public institutions, no or low level underground water, and key among them was the proper leveraging and the judicious use of funds made it possible to scale up the number of schools from 15 to 32, 8 HCFs to 12 and 42 communities instead of 20.
Turning challenges to opportunities
Other communities were coopted into the project because some target communities had very low water tables or unapproved levels of fluoride content in their underground water. The technical team explored further for communities that met the standard engineering requirements for constructing water systems. The original target communities were not abandoned but provided fetching points connected to water systems constructed in neighbouring communities.
It is instructive to note that each of the 15 targeted schools, 8 HCFs and the 20 communities had a new comprehensive WASH infrastructural facilities built for them whiles some of the additional schools, HCFs and communities had their WASH facilities renovated to acceptable standard, others also had their staffs trained in the area of capacity building, knowledge sharing, planning/budgeting and local management to properly manage existing facilities. WAG’s Programme Manager- Technical stated.
Aside this comprehensive WASH infrastructural facilities, the project also provided bio-fil technology for schools and bio-gas for Health Care Facilities to run the 14 insinuators (7 in each districts) to address its environmental challenges. He said.
One of the newly comprehensive WASH infrastructural facilities
In my interaction with Mr. Aheleh Tettey, I realised that the WASH4PH project had four (4) unique features which brought about the huge successes and the positive impact it is having on health care delivery, teaching and learning and domestic activities,
The timely interventions to supply reliable safe drinking water, handwashing facilities, improved toilet, sanitation and hygiene for the beneficiary communities need to emulate or inculcate in all government WASH projects.
The 4 unique features of WASH4PH
The four unique features are: use of institutional system instead of individuals, effective integration, water quality, and sharing of scars resources/materials used.
According to Mr. Aheleh Tettey, before the commencement of the project, his outfit realized that most of the previous projects initiated by the state or NGOs with donor support get stalled because implementers or designers of such projects fall on individuals i.e. government, appointees, sector heads, institutional heads or some few people in position instead of using the institutional based system.
He disclosed that the project during its five year of implementation saw governance changing hands from one political party to another; most appointees were change at various stages, sector heads, as well as institutional heads got transferred but in all of these changes the project was never affected because WASH4PH project implementation was based on institutional system instead of individuals.
Again the WASH4PH project became successful because there was proper and effective integration of the various Ministries, Departments and Agencies (MMDAs). WAG’s Programme Manager- Technical explained that for the lack of effective integration among various sectors often became a stumbling block during project or policy implementation thus the integration challenge was properly addressed before the start of the project.
He pointed out that even though the WASH4PH is a single project it was connected to about four different ministries i.e. ministries of health, education, sanitation & water and local government and rural development.
Those of us who have been keen watchers of activities of the various sectors know how difficult it is to bring all these ministries under one roof to undertake a single project. So for WAG and its partners to bring together these ministries under a well-coordinated manner to execute this life saving intervention is worthy to mention.
It is also fascinating to note that this singular act of bringing these ministries and other stakeholders operating in the districts together seems to end or reduce drastically the duplication of functions by the various MMDAs. For example I cannot point to a particular MMDA which is solely responsible water provision (bore-hole) in a community because there are so many MMDAs providing the same service at the same time. Meanwhile if they are well integrated these sectors one or two agencies can combined resources to execute projects.
Thank God, the designers and implementers of WASH4PH project have demonstrated that it is possible for organisations or institutions to work together for the good of the people. For instance through the implementation of the WASH4PH project, one mechanised bore-hole is serving a health care facility, school and households in one community. Hitherto, the ministry of health will provide HCFs with its own bore-hole, the ministry of education would have also done same for the schools whilst the households will be taken care by sanitation & water ministry or other ministry.
Another area that the WASH4PH project also helped to addressed especially in the Upper East region is water quality. According to Mr. Aheleh Tettey most of the underground water in the Bongo district for instance contains high fluoride.
One of the newly constructed Solar powered water systems
WAG’s Programme Manager- Technical further explained that although fluoride in water protects the teeth, it becomes very harmful when it is above certain quantity. He maintained that when the fluoride in water exceeds 1.5mlgs, it causes the teeth enamel to become pitted and discoloured.
“Before our project, we realised that most of the existing bore-holes in use by the inhabitants contained high fluoride but this was ignored because the people needed water to survive regardless of its dire health implication.
.Lots of people especially school pupils had discoloured and broken tooth because of severe fluorosis is a rare occurrences. But thankfully through this project the problem was identified and it has been addressed” He added.
For the project to live its lifespan, first the designs, technology and materials for the project were carefully selected. For example solar energy was used instead electricity from the national grid. The solar panels according to Mr. Aheleh Tettey do not use battery or inventors; it uses direct sun rays to pump water into high level tanks during day time and water flow freely during night time because of the use of gravitational stands.
Again at least two local people have been trained as mechanics to be stationed at each service station to undertake regular maintenance of the project, trained healthcare workers (HCW) on hand hygiene, safe drinking water, patient education techniques and WASH Fit teams have been put in place to monitor and supervise the maintenance of the project.
I’m of the hope that the government of Ghana will adopt WAG’s WASH4PH model and expand it to cover other health care facilities which lack comprehensive WASH across the country to end the disheartening situation where far too many pregnant mothers are required to bring their own water to wash themselves and their baby following birth.
The WASH4PH project has shown that investing in WASH infrastructure and providing ongoing operation and maintenance, require effective inter-sectoral collaboration. Such collaboration is also needed for tackling looming problems such as Antimicrobial Resistance (AMR) where lack of WASH in health care facilities leads to preventable infections.
At this point I call on state actors to support core universal health care aspects of quality, equity, and dignity for all people. Basic WASH services in health care facilities are fundamental to providing quality care and for ensuring that primary health commitments, as detailed in the Astana Declaration, are achieved.
WAG I say ayeekoo for your marvelous and lifesaving interventions
Article by Franklin ASARE-DONKOH
The writer is the National Organizer of the Ghana WASH Journalists Network (GWJN)