Democratic Republic of the Congo: Step-by-step certification process of Healthy Healthcare Facility Programme improved WASH services in 336 health care facilities
- Effective harmonization and monitoring of WASH activities require active communication between all levels of governance (national, provincial, health zone and health area) and numerous groups (implementing nongovernmental organizations, technical and financial partners and government staff).
- Provincial health offices need regular support from the national level (e.g. weekly exchanges, regular facility visits).
- Having a set of up-to-date standards in place was invaluable in the response to a recent Ebola outbreak.
Context and triggers
In 2014, a national survey carried out in nearly 1500 health care facilities revealed that the vast majority could not safely provide quality health care services to patients due to a lack of WASH facilities – almost half of these facilities had neither water nor soap available on premises.
In 2018, the MoH, in collaboration with UNICEF, designed and launched the Healthy Healthcare Facility Programme (Programme Centre de Santé Assaini or CSA). The programme, based on the WASH FIT methodology (9), uses a nine-step process for facilities to increase access to WASH services (measured by seven standards) in order to improve the quality of health care services and achieve certification. Facilities must continuously evaluate their performance, even after certification. The programme places a strong emphasis on community engagement and participation and aims to change WASH-related behaviours of health care staff, patients and visitors, while simultaneously improving environmental conditions.
Public health centres, which meet a set of criteria (accessibility, facility attendance, catchment size and level of existing WASH services) are selected by the health zone to join the programme and sign a formal agreement with the provincial health department committing to the programme. The basis of CSA, similar to WASH FIT, is a comprehensive assessment of the facility, which serves as the reference for developing and implementing an improvement plan. A facility health and safety committee (three to seven members) carries out regular assessments, oversees construction and rehabilitation of infrastructure and encourages behaviour change. Assessments are validated by the chief medical doctor of the zone, shared with the provincial health department and the National Directorate of Hygiene (MoH) to increase accountability. The health zone management team also provides support to the committee during regular facility visits.
A financial contribution from the health care facility – either local in-kind resources (labour) or basic construction materials – is required for simple construction and repair of infrastructure and consumables. More complex works such as manual or mechanical drilling, gravity or pumping adductions, rainwater harvesting, bush wells equipped with human-powered pumps or latrines made of more durable materials require external resources and expertise provided by the Government. Where local expertise is scarce, specialized nongovernmental organizations may be contracted.
The health zone management team carries out a ‘final’ survey to assess WASH conditions and, provided a satisfactory level of improvements has been made, certification is granted at a formal ceremony to recognize progress made.
As a result of the CSA programme, a total of 336 facilities attained basic WASH services and were certified accordingly. As of September 2020, an additional 159 facilities were undergoing the certification process. 2500 health care workers were also trained in IPC practices. Communities welcomed the CSA approach and facility staff were quick to embrace the programme with the understanding that it would increase the quality of health care services. As a knock-on effect, in 2019 the MoH expanded the regulatory foundation set by the seven standards to establish national standards and guidelines for WASH in health care facilities, which now serve as the main reference for implementation. These standards were particularly timely in responding to the tenth Ebola outbreak in the DRC and the ongoing COVID-19 pandemic.