Improving WASH at Healthcare Facilities for Better Maternal Health
Royal Roads University
Mary*, a mother from the Rumphi District in Malawi, had just given birth at the Rumphi Hospital. Following her labour, as per maternity protocols, she was told by her midwife to empty her bladder so her uterus could contract. However, the bathroom accessible to Mary was unusable – the toilet did not flush and the room itself was soiled. She delayed using these facilities, and sometime later collapsed on the floor of the hospital due to internal bleeding. Her uterus had not contracted and now her life was at risk. Hospital staff quickly attended to Mary, emptied her bladder, and were able to stop her bleeding before it became fatal. It was a situation that could have been easily avoided.
“If only the toilet had been safe to use in the first place!” said Grace Mgode, a nurse in the hospital’s maternity ward who is also Rumphi District’s Infection Prevention and Control (IPC) Coordinator. “As IPC Coordinator I would go to facilities to do supervision - but there was no structure. We just had committees on paper only. We would make work plans, but they were not implemented.”
The sad reality is that frequently Malawi’s healthcare facilities lack safe and effective water, sanitation, and hygiene (WASH) systems, putting patients and staff at heightened risk for infections and medical complications. The situation disproportionately affects women who choose to have a medically assisted birth in hospital. Malawi has one of the highest neonatal and maternal mortality rates in the world, with over 20% of cases attributed to sepsis alone (WaterAid, 2020). This situation further complicates the provision of safe and effective healthcare by eroding public confidence in the health system.
Funded by FIT, Royal Roads University, along with their Malawi partners Development Action for Marginalized Rural Areas (DAMRA), tested an innovative approach to improving WASH in Malawi healthcare facilities. By generating better sustained maintenance of WASH infrastructure and improving WASH practices and gender behaviours amongst healthcare staff and patients, the innovation aimed to improve the quality of care in 18 facilities in Rumphi District, thereby improving the health and well-being of patients, particularly of women and girls. The innovation was administered by an equally innovative method - the Circuit Rider approach. Circuit Riders are roving experts who visit healthcare facilities on a regular basis to provide monitoring, support, and training, particularly to 18 facility managers (6 women, 12 men), thus sustaining the innovation and generating iterative improvement.
Results of this test indicated important changes to WASH and positive impacts on women at healthcare facilities, as well as a strong desire to see the program continue. Multiple investigative tools were used across various stakeholder groups to arrive at this conclusion. These were further supported by project team observation tours and open stakeholder communications. Participants indicated that the testing period was short relative to the length of time needed for behavior and knowledge change to be detected. However, all indications point to positive, sustainable change.
“This project provided many, many benefits. WASH FIT teams were established and trained at each facility, and leaders were appointed including local leaders from within the community. When you are doing action plans or supervision you know there is a committee that meets each and every time,” said Mgode.
“To change behaviour, you can’t go today and then go back in 3 months and expect to see change. Training, capacity building, and supervision must be done regularly - but before (the test) resources didn’t allow for this. Now we have Circuit Riders regularly going there for supervision and mentorship.
Staff know someone is readily available to assist with coaching and even may sometimes come unannounced (to evaluate). I am convinced that overall, health at our facilities is improving as a result.”
* name has been changed to protect patient identity